"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"
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|4050.01||||4050.01|2632.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4050.01||||4050.01|3442.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|4050.01||||4050.01|2025.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|4050.01||||4050.01|734.83|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|4050.01||||4050.01|0|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|4050.01||||4050.01|2065.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|4050.01||||4050.01|1944.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|4050.01||||4050.01|2308.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|4050.01||||4050.01|2430.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4050.01||||4050.01|1701|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CBSA [1215]|CBSA [121500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CIGNA [1260]|CIGNA PANTEX [126003]|4050.01||||4050.01|1903.5|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CIGNA [1260]|CIGNA [126008]|4050.01||||4050.01|2940.31|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|4050.01||||4050.01|3442.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CORESOURCE [1315]|CORESOURCE [131500]|4050.01||||4050.01|2940.31|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|EQUITABLE [1355]|EQUITABLE INS [135500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|4050.01||||4050.01|1255.5|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|4050.01||||4050.01|459.27|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|4050.01||||4050.01|734.67|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|4050.01||||4050.01|3442.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|GILSBAR [1425]|GILSBAR [142500]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|4050.01||||4050.01|3442.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|4050.01||||4050.01|2025.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|GUARDIAN [1465]|GUARDIAN [146500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HEALTHNET [1495]|HEALTHNET [149500]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|4050.01||||4050.01|2940.31|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4050.01||||4050.01|2940.31|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4050.01||||4050.01|2632.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|4050.01||||4050.01|1417.5|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|4050.01||||4050.01|1701|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|4050.01||||4050.01|1701|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|4050.01||||4050.01|3442.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|4050.01||||4050.01|1903.5|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MEDICA [2910]|MEDICA HARMONY [291000]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|4050.01||||4050.01|3442.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4050.01||||4050.01|3442.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4050.01||||4050.01|2940.31|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4050.01||||4050.01|3442.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|NRECA [1735]|NRECA [173500]|4050.01||||4050.01|2482.66|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|4050.01||||4050.01|0|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4050.01||||4050.01|3442.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PHCS [1780]|FREEDOM LIFE [178009]|4050.01||||4050.01|3442.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4050.01||||4050.01|3442.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|4050.01||||4050.01|2025.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|4050.01||||4050.01|459.27|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|4050.01||||4050.01|734.67|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|Self-pay|Self-pay|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|TEXAS REHAB [1965]|SSA [196500]|4050.01||||4050.01|2308.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|4050.01||||4050.01|2308.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|TML [1980]|TML [198000]|4050.01||||4050.01|2482.66|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|TRUSTMARK [2030]|STARMARK [203000]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4050.01||||4050.01|1349.87|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UMR [2035]|UMR CHEROKEE MLR [203504]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UMR [2035]|UMR CHOICE [203500]|4050.01||||4050.01|2482.66|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UMR [2035]|UMR CORE [203505]|4050.01||||4050.01|1733.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UMR [2035]|UMR OPTIONS [203501]|4050.01||||4050.01|2944.36|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|4050.01||||4050.01|2482.66|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|4050.01||||4050.01||3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4050.01||||4050.01|2482.66|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|4050.01||||4050.01|1733.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|4050.01||||4050.01|2944.36|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|4050.01||||4050.01|3442.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|WEB TPA [2115]|WEB TPA [211500]|4050.01||||4050.01|3037.51|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|WEB TPA [2115]|WEB TPA [211501]|4050.01||||4050.01|2835.01|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|4050.01||||4050.01|437.4|3442.51|437.4
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|4050.01||||4050.01||3442.51|437.4
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|202.28||||202.28|131.48|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202.28||||202.28|171.94|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|202.28||||202.28|101.14|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|202.28||||202.28|36.7|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|202.28||||202.28|0|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|202.28||||202.28|103.16|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|202.28||||202.28|97.09|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|202.28||||202.28|115.3|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|202.28||||202.28|121.37|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202.28||||202.28|84.96|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|CBSA [1215]|CBSA [121500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|CIGNA [1260]|CIGNA PANTEX [126003]|202.28||||202.28|0|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|CIGNA [1260]|CIGNA [126008]|202.28||||202.28|146.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|202.28||||202.28|171.94|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|202.28||||202.28|146.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|EQUITABLE [1355]|EQUITABLE INS [135500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|202.28||||202.28|62.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|202.28||||202.28|22.94|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|202.28||||202.28|36.69|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|202.28||||202.28|171.94|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|GILSBAR [1425]|GILSBAR [142500]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|202.28||||202.28|171.94|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|202.28||||202.28|101.14|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|GUARDIAN [1465]|GUARDIAN [146500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|202.28||||202.28|146.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202.28||||202.28|146.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|202.28||||202.28|131.48|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|202.28||||202.28|70.8|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|202.28||||202.28|84.96|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|202.28||||202.28|84.96|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|202.28||||202.28|171.94|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|202.28||||202.28|95.07|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|MEDICA [2910]|MEDICA HARMONY [291000]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|202.28||||202.28|171.94|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202.28||||202.28|171.94|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|202.28||||202.28|146.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|202.28||||202.28|171.94|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|NRECA [1735]|NRECA [173500]|202.28||||202.28|124|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|202.28||||202.28|0|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|202.28||||202.28|171.94|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|PHCS [1780]|FREEDOM LIFE [178009]|202.28||||202.28|171.94|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|202.28||||202.28|171.94|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|202.28||||202.28|101.14|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|202.28||||202.28|22.94|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|202.28||||202.28|36.69|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|Self-pay|Self-pay|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|TEXAS REHAB [1965]|SSA [196500]|202.28||||202.28|115.3|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|202.28||||202.28|115.3|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|TML [1980]|TML [198000]|202.28||||202.28|124|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|TRUSTMARK [2030]|STARMARK [203000]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202.28||||202.28|67.42|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UMR [2035]|UMR CHEROKEE MLR [203504]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UMR [2035]|UMR CHOICE [203500]|202.28||||202.28|124|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UMR [2035]|UMR CORE [203505]|202.28||||202.28|86.57|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UMR [2035]|UMR OPTIONS [203501]|202.28||||202.28|147.06|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|202.28||||202.28|124|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|202.28||||202.28||171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202.28||||202.28|124|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|202.28||||202.28|86.57|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|202.28||||202.28|147.06|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|202.28||||202.28|171.94|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|WEB TPA [2115]|WEB TPA [211500]|202.28||||202.28|151.71|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|WEB TPA [2115]|WEB TPA [211501]|202.28||||202.28|141.59|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|202.28||||202.28|21.85|171.94|21.85
10001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP CRUCIFORM LOW PROFILE HEAD NONSTERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|202.28||||202.28||171.94|21.85
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|6050.05||||6050.05|3932.53|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6050.05||||6050.05|5142.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|6050.05||||6050.05|3025.02|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6050.05||||6050.05|1097.72|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|6050.05||||6050.05|0|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|6050.05||||6050.05|3085.52|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|6050.05||||6050.05|2904.02|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|6050.05||||6050.05|3448.53|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|6050.05||||6050.05|3630.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6050.05||||6050.05|2541.02|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CBSA [1215]|CBSA [121500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CIGNA [1260]|CIGNA PANTEX [126003]|6050.05||||6050.05|2843.52|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CIGNA [1260]|CIGNA [126008]|6050.05||||6050.05|4392.34|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|6050.05||||6050.05|5142.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CORESOURCE [1315]|CORESOURCE [131500]|6050.05||||6050.05|4392.34|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|EQUITABLE [1355]|EQUITABLE INS [135500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|6050.05||||6050.05|1875.52|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|6050.05||||6050.05|686.08|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|6050.05||||6050.05|1097.48|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|6050.05||||6050.05|5142.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|GILSBAR [1425]|GILSBAR [142500]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|6050.05||||6050.05|5142.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|6050.05||||6050.05|3025.02|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|GUARDIAN [1465]|GUARDIAN [146500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHNET [1495]|HEALTHNET [149500]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6050.05||||6050.05|4392.34|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6050.05||||6050.05|4392.34|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6050.05||||6050.05|3932.53|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|6050.05||||6050.05|2117.52|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|6050.05||||6050.05|2541.02|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|6050.05||||6050.05|2541.02|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|6050.05||||6050.05|5142.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|6050.05||||6050.05|2843.52|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MEDICA [2910]|MEDICA HARMONY [291000]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|6050.05||||6050.05|5142.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6050.05||||6050.05|5142.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6050.05||||6050.05|4392.34|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|6050.05||||6050.05|5142.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|NRECA [1735]|NRECA [173500]|6050.05||||6050.05|3708.68|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|6050.05||||6050.05|0|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6050.05||||6050.05|5142.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PHCS [1780]|FREEDOM LIFE [178009]|6050.05||||6050.05|5142.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|6050.05||||6050.05|5142.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|6050.05||||6050.05|3025.02|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|6050.05||||6050.05|686.08|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|6050.05||||6050.05|1097.48|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|Self-pay|Self-pay|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|TEXAS REHAB [1965]|SSA [196500]|6050.05||||6050.05|3448.53|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|6050.05||||6050.05|3448.53|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|TML [1980]|TML [198000]|6050.05||||6050.05|3708.68|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|TRUSTMARK [2030]|STARMARK [203000]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6050.05||||6050.05|2016.48|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR [2035]|UMR CHEROKEE MLR [203504]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR [2035]|UMR CHOICE [203500]|6050.05||||6050.05|3708.68|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR [2035]|UMR CORE [203505]|6050.05||||6050.05|2589.42|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR [2035]|UMR OPTIONS [203501]|6050.05||||6050.05|4398.39|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|6050.05||||6050.05|3708.68|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|6050.05||||6050.05||5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6050.05||||6050.05|3708.68|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|6050.05||||6050.05|2589.42|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|6050.05||||6050.05|4398.39|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6050.05||||6050.05|5142.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|WEB TPA [2115]|WEB TPA [211500]|6050.05||||6050.05|4537.54|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|WEB TPA [2115]|WEB TPA [211501]|6050.05||||6050.05|4235.03|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|6050.05||||6050.05|653.41|5142.54|653.41
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|6050.05||||6050.05||5142.54|653.41
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|202.28||||202.28|131.48|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202.28||||202.28|171.94|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|202.28||||202.28|101.14|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|202.28||||202.28|36.7|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|202.28||||202.28|0|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|202.28||||202.28|103.16|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|202.28||||202.28|97.09|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|202.28||||202.28|115.3|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|202.28||||202.28|121.37|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202.28||||202.28|84.96|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|CBSA [1215]|CBSA [121500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA PANTEX [126003]|202.28||||202.28|0|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA [126008]|202.28||||202.28|146.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|202.28||||202.28|171.94|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|CORESOURCE [1315]|CORESOURCE [131500]|202.28||||202.28|146.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|EQUITABLE [1355]|EQUITABLE INS [135500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|202.28||||202.28|62.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|202.28||||202.28|22.94|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|202.28||||202.28|36.69|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|202.28||||202.28|171.94|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|GILSBAR [1425]|GILSBAR [142500]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|202.28||||202.28|171.94|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|202.28||||202.28|101.14|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|GUARDIAN [1465]|GUARDIAN [146500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|HEALTHNET [1495]|HEALTHNET [149500]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|202.28||||202.28|146.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202.28||||202.28|146.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|202.28||||202.28|131.48|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|202.28||||202.28|70.8|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|202.28||||202.28|84.96|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|202.28||||202.28|84.96|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|202.28||||202.28|171.94|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|202.28||||202.28|95.07|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|MEDICA [2910]|MEDICA HARMONY [291000]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|202.28||||202.28|171.94|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202.28||||202.28|171.94|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|202.28||||202.28|146.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|202.28||||202.28|171.94|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|NRECA [1735]|NRECA [173500]|202.28||||202.28|124|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|202.28||||202.28|0|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|202.28||||202.28|171.94|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|PHCS [1780]|FREEDOM LIFE [178009]|202.28||||202.28|171.94|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|PHCS [1780]|PHCS MULTIPLAN [178000]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|202.28||||202.28|171.94|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|202.28||||202.28|101.14|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|202.28||||202.28|22.94|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|202.28||||202.28|36.69|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|Self-pay|Self-pay|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|TEXAS REHAB [1965]|SSA [196500]|202.28||||202.28|115.3|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|202.28||||202.28|115.3|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|TML [1980]|TML [198000]|202.28||||202.28|124|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|TRUSTMARK [2030]|STARMARK [203000]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202.28||||202.28|67.42|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UMR [2035]|UMR CHEROKEE MLR [203504]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UMR [2035]|UMR CHOICE [203500]|202.28||||202.28|124|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UMR [2035]|UMR CORE [203505]|202.28||||202.28|86.57|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UMR [2035]|UMR OPTIONS [203501]|202.28||||202.28|147.06|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|202.28||||202.28|124|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|202.28||||202.28||171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202.28||||202.28|124|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|202.28||||202.28|86.57|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|202.28||||202.28|147.06|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|202.28||||202.28|171.94|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|WEB TPA [2115]|WEB TPA [211500]|202.28||||202.28|151.71|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|WEB TPA [2115]|WEB TPA [211501]|202.28||||202.28|141.59|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|202.28||||202.28|21.85|171.94|21.85
10002|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L11 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE CRUCIFORM NONSTERILE MODULAR HAND SYSTEM|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|202.28||||202.28||171.94|21.85
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|6050.05||||6050.05|3932.53|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6050.05||||6050.05|5142.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|6050.05||||6050.05|3025.02|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6050.05||||6050.05|1097.72|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|6050.05||||6050.05|0|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|6050.05||||6050.05|3085.52|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|6050.05||||6050.05|2904.02|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|6050.05||||6050.05|3448.53|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|6050.05||||6050.05|3630.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6050.05||||6050.05|2541.02|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CBSA [1215]|CBSA [121500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CIGNA [1260]|CIGNA PANTEX [126003]|6050.05||||6050.05|2843.52|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CIGNA [1260]|CIGNA [126008]|6050.05||||6050.05|4392.34|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|6050.05||||6050.05|5142.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CORESOURCE [1315]|CORESOURCE [131500]|6050.05||||6050.05|4392.34|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|EQUITABLE [1355]|EQUITABLE INS [135500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|6050.05||||6050.05|1875.52|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|6050.05||||6050.05|686.08|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|6050.05||||6050.05|1097.48|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|6050.05||||6050.05|5142.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|GILSBAR [1425]|GILSBAR [142500]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|6050.05||||6050.05|5142.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|6050.05||||6050.05|3025.02|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|GUARDIAN [1465]|GUARDIAN [146500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHNET [1495]|HEALTHNET [149500]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6050.05||||6050.05|4392.34|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6050.05||||6050.05|4392.34|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6050.05||||6050.05|3932.53|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|6050.05||||6050.05|2117.52|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|6050.05||||6050.05|2541.02|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|6050.05||||6050.05|2541.02|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|6050.05||||6050.05|5142.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|6050.05||||6050.05|2843.52|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MEDICA [2910]|MEDICA HARMONY [291000]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|6050.05||||6050.05|5142.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6050.05||||6050.05|5142.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6050.05||||6050.05|4392.34|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|6050.05||||6050.05|5142.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|NRECA [1735]|NRECA [173500]|6050.05||||6050.05|3708.68|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|6050.05||||6050.05|0|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6050.05||||6050.05|5142.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PHCS [1780]|FREEDOM LIFE [178009]|6050.05||||6050.05|5142.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|6050.05||||6050.05|5142.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|6050.05||||6050.05|3025.02|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|6050.05||||6050.05|686.08|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|6050.05||||6050.05|1097.48|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|Self-pay|Self-pay|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|TEXAS REHAB [1965]|SSA [196500]|6050.05||||6050.05|3448.53|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|6050.05||||6050.05|3448.53|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|TML [1980]|TML [198000]|6050.05||||6050.05|3708.68|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|TRUSTMARK [2030]|STARMARK [203000]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6050.05||||6050.05|2016.48|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR [2035]|UMR CHEROKEE MLR [203504]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR [2035]|UMR CHOICE [203500]|6050.05||||6050.05|3708.68|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR [2035]|UMR CORE [203505]|6050.05||||6050.05|2589.42|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR [2035]|UMR OPTIONS [203501]|6050.05||||6050.05|4398.39|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|6050.05||||6050.05|3708.68|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|6050.05||||6050.05||5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6050.05||||6050.05|3708.68|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|6050.05||||6050.05|2589.42|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|6050.05||||6050.05|4398.39|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6050.05||||6050.05|5142.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|WEB TPA [2115]|WEB TPA [211500]|6050.05||||6050.05|4537.54|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|WEB TPA [2115]|WEB TPA [211501]|6050.05||||6050.05|4235.03|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|6050.05||||6050.05|653.41|5142.54|653.41
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|6050.05||||6050.05|3932.53|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6050.05||||6050.05|5142.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|6050.05||||6050.05|3025.02|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6050.05||||6050.05|1097.72|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|6050.05||||6050.05|0|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|6050.05||||6050.05|3085.52|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|6050.05||||6050.05|2904.02|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|6050.05||||6050.05|3448.53|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|6050.05||||6050.05|3630.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6050.05||||6050.05|2541.02|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CBSA [1215]|CBSA [121500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA [1260]|CIGNA PANTEX [126003]|6050.05||||6050.05|2843.52|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA [1260]|CIGNA [126008]|6050.05||||6050.05|4392.34|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|6050.05||||6050.05|5142.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|6050.05||||6050.05|4392.34|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|EQUITABLE [1355]|EQUITABLE INS [135500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|6050.05||||6050.05|1875.52|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|6050.05||||6050.05|686.08|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|6050.05||||6050.05|1097.48|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|6050.05||||6050.05|5142.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GILSBAR [1425]|GILSBAR [142500]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|6050.05||||6050.05|5142.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|6050.05||||6050.05|3025.02|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GUARDIAN [1465]|GUARDIAN [146500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6050.05||||6050.05|4392.34|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6050.05||||6050.05|4392.34|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6050.05||||6050.05|3932.53|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|6050.05||||6050.05|2117.52|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|6050.05||||6050.05|2541.02|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|6050.05||||6050.05|2541.02|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|6050.05||||6050.05|5142.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|6050.05||||6050.05|2843.52|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MEDICA [2910]|MEDICA HARMONY [291000]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|6050.05||||6050.05|5142.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6050.05||||6050.05|5142.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6050.05||||6050.05|4392.34|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|6050.05||||6050.05|5142.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NRECA [1735]|NRECA [173500]|6050.05||||6050.05|3708.68|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|6050.05||||6050.05|0|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6050.05||||6050.05|5142.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PHCS [1780]|FREEDOM LIFE [178009]|6050.05||||6050.05|5142.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|6050.05||||6050.05|5142.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|6050.05||||6050.05|3025.02|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|6050.05||||6050.05|686.08|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|6050.05||||6050.05|1097.48|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|Self-pay|Self-pay|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TEXAS REHAB [1965]|SSA [196500]|6050.05||||6050.05|3448.53|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|6050.05||||6050.05|3448.53|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TML [1980]|TML [198000]|6050.05||||6050.05|3708.68|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRUSTMARK [2030]|STARMARK [203000]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6050.05||||6050.05|2016.48|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR CHEROKEE MLR [203504]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR CHOICE [203500]|6050.05||||6050.05|3708.68|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR CORE [203505]|6050.05||||6050.05|2589.42|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR OPTIONS [203501]|6050.05||||6050.05|4398.39|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|6050.05||||6050.05|3708.68|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|6050.05||||6050.05||5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6050.05||||6050.05|3708.68|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|6050.05||||6050.05|2589.42|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|6050.05||||6050.05|4398.39|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6050.05||||6050.05|5142.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WEB TPA [2115]|WEB TPA [211500]|6050.05||||6050.05|4537.54|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WEB TPA [2115]|WEB TPA [211501]|6050.05||||6050.05|4235.03|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|6050.05||||6050.05|653.41|5142.54|653.41
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|6050.05||||6050.05||5142.54|653.41
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|202.28||||202.28|131.48|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202.28||||202.28|171.94|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|202.28||||202.28|101.14|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|202.28||||202.28|36.7|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|202.28||||202.28|0|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|202.28||||202.28|103.16|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|202.28||||202.28|97.09|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|202.28||||202.28|115.3|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|202.28||||202.28|121.37|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202.28||||202.28|84.96|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CBSA [1215]|CBSA [121500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA PANTEX [126003]|202.28||||202.28|0|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA [126008]|202.28||||202.28|146.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|202.28||||202.28|171.94|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CORESOURCE [1315]|CORESOURCE [131500]|202.28||||202.28|146.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|EQUITABLE [1355]|EQUITABLE INS [135500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|202.28||||202.28|62.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|202.28||||202.28|22.94|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|202.28||||202.28|36.69|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|202.28||||202.28|171.94|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GILSBAR [1425]|GILSBAR [142500]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|202.28||||202.28|171.94|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|202.28||||202.28|101.14|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GUARDIAN [1465]|GUARDIAN [146500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHNET [1495]|HEALTHNET [149500]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|202.28||||202.28|146.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202.28||||202.28|146.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|202.28||||202.28|131.48|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|202.28||||202.28|70.8|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|202.28||||202.28|84.96|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|202.28||||202.28|84.96|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|202.28||||202.28|171.94|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|202.28||||202.28|95.07|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEDICA [2910]|MEDICA HARMONY [291000]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|202.28||||202.28|171.94|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202.28||||202.28|171.94|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|202.28||||202.28|146.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|202.28||||202.28|171.94|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NRECA [1735]|NRECA [173500]|202.28||||202.28|124|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|202.28||||202.28|0|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|202.28||||202.28|171.94|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHCS [1780]|FREEDOM LIFE [178009]|202.28||||202.28|171.94|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHCS [1780]|PHCS MULTIPLAN [178000]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|202.28||||202.28|171.94|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|202.28||||202.28|101.14|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|202.28||||202.28|22.94|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|202.28||||202.28|36.69|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|Self-pay|Self-pay|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS REHAB [1965]|SSA [196500]|202.28||||202.28|115.3|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|202.28||||202.28|115.3|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TML [1980]|TML [198000]|202.28||||202.28|124|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRUSTMARK [2030]|STARMARK [203000]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202.28||||202.28|67.42|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CHEROKEE MLR [203504]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CHOICE [203500]|202.28||||202.28|124|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CORE [203505]|202.28||||202.28|86.57|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR OPTIONS [203501]|202.28||||202.28|147.06|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|202.28||||202.28|124|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|202.28||||202.28||171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202.28||||202.28|124|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|202.28||||202.28|86.57|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|202.28||||202.28|147.06|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|202.28||||202.28|171.94|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WEB TPA [2115]|WEB TPA [211500]|202.28||||202.28|151.71|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WEB TPA [2115]|WEB TPA [211501]|202.28||||202.28|141.59|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|202.28||||202.28|21.85|171.94|21.85
10003|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|202.28||||202.28||171.94|21.85
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|6050.05||||6050.05|3932.53|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6050.05||||6050.05|5142.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|6050.05||||6050.05|3025.02|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6050.05||||6050.05|1097.72|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|6050.05||||6050.05|0|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|6050.05||||6050.05|3085.52|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|6050.05||||6050.05|2904.02|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|6050.05||||6050.05|3448.53|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|6050.05||||6050.05|3630.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6050.05||||6050.05|2541.02|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CBSA [1215]|CBSA [121500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA [1260]|CIGNA PANTEX [126003]|6050.05||||6050.05|2843.52|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA [1260]|CIGNA [126008]|6050.05||||6050.05|4392.34|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|6050.05||||6050.05|5142.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|6050.05||||6050.05|4392.34|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|EQUITABLE [1355]|EQUITABLE INS [135500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|6050.05||||6050.05|1875.52|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|6050.05||||6050.05|686.08|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|6050.05||||6050.05|1097.48|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|6050.05||||6050.05|5142.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GILSBAR [1425]|GILSBAR [142500]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|6050.05||||6050.05|5142.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|6050.05||||6050.05|3025.02|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GUARDIAN [1465]|GUARDIAN [146500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6050.05||||6050.05|4392.34|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6050.05||||6050.05|4392.34|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6050.05||||6050.05|3932.53|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|6050.05||||6050.05|2117.52|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|6050.05||||6050.05|2541.02|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|6050.05||||6050.05|2541.02|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|6050.05||||6050.05|5142.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|6050.05||||6050.05|2843.52|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MEDICA [2910]|MEDICA HARMONY [291000]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|6050.05||||6050.05|5142.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6050.05||||6050.05|5142.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6050.05||||6050.05|4392.34|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|6050.05||||6050.05|5142.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NRECA [1735]|NRECA [173500]|6050.05||||6050.05|3708.68|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|6050.05||||6050.05|0|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6050.05||||6050.05|5142.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PHCS [1780]|FREEDOM LIFE [178009]|6050.05||||6050.05|5142.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|6050.05||||6050.05|5142.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|6050.05||||6050.05|3025.02|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|6050.05||||6050.05|686.08|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|6050.05||||6050.05|1097.48|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|Self-pay|Self-pay|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TEXAS REHAB [1965]|SSA [196500]|6050.05||||6050.05|3448.53|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|6050.05||||6050.05|3448.53|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TML [1980]|TML [198000]|6050.05||||6050.05|3708.68|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRUSTMARK [2030]|STARMARK [203000]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6050.05||||6050.05|2016.48|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR CHEROKEE MLR [203504]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR CHOICE [203500]|6050.05||||6050.05|3708.68|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR CORE [203505]|6050.05||||6050.05|2589.42|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR OPTIONS [203501]|6050.05||||6050.05|4398.39|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|6050.05||||6050.05|3708.68|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|6050.05||||6050.05||5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6050.05||||6050.05|3708.68|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|6050.05||||6050.05|2589.42|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|6050.05||||6050.05|4398.39|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6050.05||||6050.05|5142.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WEB TPA [2115]|WEB TPA [211500]|6050.05||||6050.05|4537.54|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WEB TPA [2115]|WEB TPA [211501]|6050.05||||6050.05|4235.03|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|6050.05||||6050.05|653.41|5142.54|653.41
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|6050.05||||6050.05|3932.53|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6050.05||||6050.05|5142.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|6050.05||||6050.05|3025.02|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6050.05||||6050.05|1097.72|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|6050.05||||6050.05|0|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|6050.05||||6050.05|3085.52|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|6050.05||||6050.05|2904.02|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|6050.05||||6050.05|3448.53|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|6050.05||||6050.05|3630.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6050.05||||6050.05|2541.02|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CBSA [1215]|CBSA [121500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA [1260]|CIGNA PANTEX [126003]|6050.05||||6050.05|2843.52|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA [1260]|CIGNA [126008]|6050.05||||6050.05|4392.34|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|6050.05||||6050.05|5142.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|6050.05||||6050.05|4392.34|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|EQUITABLE [1355]|EQUITABLE INS [135500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|6050.05||||6050.05|1875.52|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|6050.05||||6050.05|686.08|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|6050.05||||6050.05|1097.48|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|6050.05||||6050.05|5142.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GILSBAR [1425]|GILSBAR [142500]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|6050.05||||6050.05|5142.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|6050.05||||6050.05|3025.02|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GUARDIAN [1465]|GUARDIAN [146500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6050.05||||6050.05|4392.34|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6050.05||||6050.05|4392.34|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6050.05||||6050.05|3932.53|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|6050.05||||6050.05|2117.52|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|6050.05||||6050.05|2541.02|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|6050.05||||6050.05|2541.02|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|6050.05||||6050.05|5142.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|6050.05||||6050.05|2843.52|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MEDICA [2910]|MEDICA HARMONY [291000]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|6050.05||||6050.05|5142.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6050.05||||6050.05|5142.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6050.05||||6050.05|4392.34|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|6050.05||||6050.05|5142.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NRECA [1735]|NRECA [173500]|6050.05||||6050.05|3708.68|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|6050.05||||6050.05|0|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6050.05||||6050.05|5142.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PHCS [1780]|FREEDOM LIFE [178009]|6050.05||||6050.05|5142.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|6050.05||||6050.05|5142.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|6050.05||||6050.05|3025.02|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|6050.05||||6050.05|686.08|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|6050.05||||6050.05|1097.48|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|Self-pay|Self-pay|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TEXAS REHAB [1965]|SSA [196500]|6050.05||||6050.05|3448.53|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|6050.05||||6050.05|3448.53|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TML [1980]|TML [198000]|6050.05||||6050.05|3708.68|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRUSTMARK [2030]|STARMARK [203000]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6050.05||||6050.05|2016.48|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR CHEROKEE MLR [203504]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR CHOICE [203500]|6050.05||||6050.05|3708.68|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR CORE [203505]|6050.05||||6050.05|2589.42|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR OPTIONS [203501]|6050.05||||6050.05|4398.39|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|6050.05||||6050.05|3708.68|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|6050.05||||6050.05||5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6050.05||||6050.05|3708.68|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|6050.05||||6050.05|2589.42|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|6050.05||||6050.05|4398.39|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6050.05||||6050.05|5142.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WEB TPA [2115]|WEB TPA [211500]|6050.05||||6050.05|4537.54|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WEB TPA [2115]|WEB TPA [211501]|6050.05||||6050.05|4235.03|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|6050.05||||6050.05|653.41|5142.54|653.41
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|6050.05||||6050.05||5142.54|653.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|517.89||||517.89|336.63|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|517.89||||517.89|440.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|517.89||||517.89|258.94|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|517.89||||517.89|93.97|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|517.89||||517.89|0|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|517.89||||517.89|264.12|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|517.89||||517.89|248.59|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|517.89||||517.89|295.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|517.89||||517.89|310.73|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|517.89||||517.89|217.51|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CBSA [1215]|CBSA [121500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA PANTEX [126003]|517.89||||517.89|243.41|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA [126008]|517.89||||517.89|375.99|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|517.89||||517.89|440.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORESOURCE [1315]|CORESOURCE [131500]|517.89||||517.89|375.99|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EQUITABLE [1355]|EQUITABLE INS [135500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|517.89||||517.89|160.55|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|517.89||||517.89|58.73|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|517.89||||517.89|93.94|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|517.89||||517.89|440.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GILSBAR [1425]|GILSBAR [142500]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|517.89||||517.89|440.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|517.89||||517.89|258.94|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GUARDIAN [1465]|GUARDIAN [146500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHNET [1495]|HEALTHNET [149500]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|517.89||||517.89|375.99|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|517.89||||517.89|375.99|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|517.89||||517.89|336.63|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|517.89||||517.89|181.26|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|517.89||||517.89|217.51|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|517.89||||517.89|217.51|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|517.89||||517.89|440.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|517.89||||517.89|243.41|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MEDICA [2910]|MEDICA HARMONY [291000]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|517.89||||517.89|440.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|517.89||||517.89|440.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|517.89||||517.89|375.99|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|517.89||||517.89|440.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NRECA [1735]|NRECA [173500]|517.89||||517.89|317.47|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|517.89||||517.89|0|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|517.89||||517.89|440.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHCS [1780]|FREEDOM LIFE [178009]|517.89||||517.89|440.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHCS [1780]|PHCS MULTIPLAN [178000]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|517.89||||517.89|440.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|517.89||||517.89|258.94|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|517.89||||517.89|58.73|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|517.89||||517.89|93.94|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|Self-pay|Self-pay|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TEXAS REHAB [1965]|SSA [196500]|517.89||||517.89|295.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|517.89||||517.89|295.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TML [1980]|TML [198000]|517.89||||517.89|317.47|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|STARMARK [203000]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|517.89||||517.89|172.61|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR CHEROKEE MLR [203504]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR CHOICE [203500]|517.89||||517.89|317.47|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR CORE [203505]|517.89||||517.89|221.66|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR OPTIONS [203501]|517.89||||517.89|376.5|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|517.89||||517.89|317.47|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|517.89||||517.89||440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|517.89||||517.89|317.47|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|517.89||||517.89|221.66|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|517.89||||517.89|376.5|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|517.89||||517.89|440.2|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WEB TPA [2115]|WEB TPA [211500]|517.89||||517.89|388.42|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WEB TPA [2115]|WEB TPA [211501]|517.89||||517.89|362.52|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|517.89||||517.89|55.93|440.2|55.93
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|517.89||||517.89|336.63|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|517.89||||517.89|440.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|517.89||||517.89|258.94|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|517.89||||517.89|93.97|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|517.89||||517.89|0|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|517.89||||517.89|264.12|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|517.89||||517.89|248.59|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|517.89||||517.89|295.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|517.89||||517.89|310.73|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|517.89||||517.89|217.51|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CBSA [1215]|CBSA [121500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA PANTEX [126003]|517.89||||517.89|243.41|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA [126008]|517.89||||517.89|375.99|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|517.89||||517.89|440.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORESOURCE [1315]|CORESOURCE [131500]|517.89||||517.89|375.99|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EQUITABLE [1355]|EQUITABLE INS [135500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|517.89||||517.89|160.55|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|517.89||||517.89|58.73|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|517.89||||517.89|93.94|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|517.89||||517.89|440.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GILSBAR [1425]|GILSBAR [142500]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|517.89||||517.89|440.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|517.89||||517.89|258.94|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GUARDIAN [1465]|GUARDIAN [146500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHNET [1495]|HEALTHNET [149500]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|517.89||||517.89|375.99|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|517.89||||517.89|375.99|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|517.89||||517.89|336.63|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|517.89||||517.89|181.26|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|517.89||||517.89|217.51|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|517.89||||517.89|217.51|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|517.89||||517.89|440.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|517.89||||517.89|243.41|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MEDICA [2910]|MEDICA HARMONY [291000]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|517.89||||517.89|440.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|517.89||||517.89|440.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|517.89||||517.89|375.99|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|517.89||||517.89|440.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NRECA [1735]|NRECA [173500]|517.89||||517.89|317.47|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|517.89||||517.89|0|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|517.89||||517.89|440.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHCS [1780]|FREEDOM LIFE [178009]|517.89||||517.89|440.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHCS [1780]|PHCS MULTIPLAN [178000]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|517.89||||517.89|440.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|517.89||||517.89|258.94|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|517.89||||517.89|58.73|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|517.89||||517.89|93.94|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|Self-pay|Self-pay|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TEXAS REHAB [1965]|SSA [196500]|517.89||||517.89|295.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|517.89||||517.89|295.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TML [1980]|TML [198000]|517.89||||517.89|317.47|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|STARMARK [203000]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|517.89||||517.89|172.61|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR CHEROKEE MLR [203504]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR CHOICE [203500]|517.89||||517.89|317.47|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR CORE [203505]|517.89||||517.89|221.66|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR OPTIONS [203501]|517.89||||517.89|376.5|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|517.89||||517.89|317.47|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|517.89||||517.89||440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|517.89||||517.89|317.47|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|517.89||||517.89|221.66|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|517.89||||517.89|376.5|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|517.89||||517.89|440.2|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WEB TPA [2115]|WEB TPA [211500]|517.89||||517.89|388.42|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WEB TPA [2115]|WEB TPA [211501]|517.89||||517.89|362.52|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|517.89||||517.89|55.93|440.2|55.93
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|517.89||||517.89|336.63|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|517.89||||517.89|440.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|517.89||||517.89|258.94|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|517.89||||517.89|93.97|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|517.89||||517.89|0|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|517.89||||517.89|264.12|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|517.89||||517.89|248.59|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|517.89||||517.89|295.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|517.89||||517.89|310.73|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|517.89||||517.89|217.51|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CBSA [1215]|CBSA [121500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA PANTEX [126003]|517.89||||517.89|243.41|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA [126008]|517.89||||517.89|375.99|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|517.89||||517.89|440.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORESOURCE [1315]|CORESOURCE [131500]|517.89||||517.89|375.99|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EQUITABLE [1355]|EQUITABLE INS [135500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|517.89||||517.89|160.55|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|517.89||||517.89|58.73|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|517.89||||517.89|93.94|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|517.89||||517.89|440.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GILSBAR [1425]|GILSBAR [142500]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|517.89||||517.89|440.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|517.89||||517.89|258.94|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GUARDIAN [1465]|GUARDIAN [146500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHNET [1495]|HEALTHNET [149500]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|517.89||||517.89|375.99|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|517.89||||517.89|375.99|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|517.89||||517.89|336.63|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|517.89||||517.89|181.26|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|517.89||||517.89|217.51|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|517.89||||517.89|217.51|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|517.89||||517.89|440.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|517.89||||517.89|243.41|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MEDICA [2910]|MEDICA HARMONY [291000]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|517.89||||517.89|440.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|517.89||||517.89|440.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|517.89||||517.89|375.99|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|517.89||||517.89|440.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NRECA [1735]|NRECA [173500]|517.89||||517.89|317.47|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|517.89||||517.89|0|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|517.89||||517.89|440.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHCS [1780]|FREEDOM LIFE [178009]|517.89||||517.89|440.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHCS [1780]|PHCS MULTIPLAN [178000]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|517.89||||517.89|440.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|517.89||||517.89|258.94|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|517.89||||517.89|58.73|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|517.89||||517.89|93.94|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|Self-pay|Self-pay|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TEXAS REHAB [1965]|SSA [196500]|517.89||||517.89|295.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|517.89||||517.89|295.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TML [1980]|TML [198000]|517.89||||517.89|317.47|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|STARMARK [203000]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|517.89||||517.89|172.61|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR CHEROKEE MLR [203504]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR CHOICE [203500]|517.89||||517.89|317.47|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR CORE [203505]|517.89||||517.89|221.66|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR OPTIONS [203501]|517.89||||517.89|376.5|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|517.89||||517.89|317.47|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|517.89||||517.89||440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|517.89||||517.89|317.47|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|517.89||||517.89|221.66|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|517.89||||517.89|376.5|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|517.89||||517.89|440.2|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WEB TPA [2115]|WEB TPA [211500]|517.89||||517.89|388.42|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WEB TPA [2115]|WEB TPA [211501]|517.89||||517.89|362.52|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|517.89||||517.89|55.93|440.2|55.93
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|517.89||||517.89|336.63|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|517.89||||517.89|440.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|517.89||||517.89|258.94|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|517.89||||517.89|93.97|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|517.89||||517.89|0|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|517.89||||517.89|264.12|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|517.89||||517.89|248.59|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|517.89||||517.89|295.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|517.89||||517.89|310.73|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|517.89||||517.89|217.51|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CBSA [1215]|CBSA [121500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA PANTEX [126003]|517.89||||517.89|243.41|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA [126008]|517.89||||517.89|375.99|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|517.89||||517.89|440.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORESOURCE [1315]|CORESOURCE [131500]|517.89||||517.89|375.99|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EQUITABLE [1355]|EQUITABLE INS [135500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|517.89||||517.89|160.55|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|517.89||||517.89|58.73|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|517.89||||517.89|93.94|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|517.89||||517.89|440.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GILSBAR [1425]|GILSBAR [142500]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|517.89||||517.89|440.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|517.89||||517.89|258.94|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GUARDIAN [1465]|GUARDIAN [146500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHNET [1495]|HEALTHNET [149500]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|517.89||||517.89|375.99|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|517.89||||517.89|375.99|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|517.89||||517.89|336.63|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|517.89||||517.89|181.26|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|517.89||||517.89|217.51|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|517.89||||517.89|217.51|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|517.89||||517.89|440.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|517.89||||517.89|243.41|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MEDICA [2910]|MEDICA HARMONY [291000]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|517.89||||517.89|440.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|517.89||||517.89|440.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|517.89||||517.89|375.99|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|517.89||||517.89|440.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NRECA [1735]|NRECA [173500]|517.89||||517.89|317.47|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|517.89||||517.89|0|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|517.89||||517.89|440.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHCS [1780]|FREEDOM LIFE [178009]|517.89||||517.89|440.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHCS [1780]|PHCS MULTIPLAN [178000]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|517.89||||517.89|440.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|517.89||||517.89|258.94|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|517.89||||517.89|58.73|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|517.89||||517.89|93.94|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|Self-pay|Self-pay|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TEXAS REHAB [1965]|SSA [196500]|517.89||||517.89|295.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|517.89||||517.89|295.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TML [1980]|TML [198000]|517.89||||517.89|317.47|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|STARMARK [203000]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|517.89||||517.89|172.61|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR CHEROKEE MLR [203504]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR CHOICE [203500]|517.89||||517.89|317.47|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR CORE [203505]|517.89||||517.89|221.66|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR OPTIONS [203501]|517.89||||517.89|376.5|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|517.89||||517.89|317.47|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|517.89||||517.89||440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|517.89||||517.89|317.47|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|517.89||||517.89|221.66|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|517.89||||517.89|376.5|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|517.89||||517.89|440.2|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WEB TPA [2115]|WEB TPA [211500]|517.89||||517.89|388.42|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WEB TPA [2115]|WEB TPA [211501]|517.89||||517.89|362.52|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|517.89||||517.89|55.93|440.2|55.93
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|517.89||||517.89||440.2|55.93
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|202.28||||202.28|131.48|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202.28||||202.28|171.94|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|202.28||||202.28|101.14|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|202.28||||202.28|36.7|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|202.28||||202.28|0|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|202.28||||202.28|103.16|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|202.28||||202.28|97.09|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|202.28||||202.28|115.3|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|202.28||||202.28|121.37|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202.28||||202.28|84.96|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CBSA [1215]|CBSA [121500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA PANTEX [126003]|202.28||||202.28|0|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA [126008]|202.28||||202.28|146.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|202.28||||202.28|171.94|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CORESOURCE [1315]|CORESOURCE [131500]|202.28||||202.28|146.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|EQUITABLE [1355]|EQUITABLE INS [135500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|202.28||||202.28|62.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|202.28||||202.28|22.94|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|202.28||||202.28|36.69|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|202.28||||202.28|171.94|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GILSBAR [1425]|GILSBAR [142500]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|202.28||||202.28|171.94|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|202.28||||202.28|101.14|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GUARDIAN [1465]|GUARDIAN [146500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHNET [1495]|HEALTHNET [149500]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|202.28||||202.28|146.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202.28||||202.28|146.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|202.28||||202.28|131.48|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|202.28||||202.28|70.8|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|202.28||||202.28|84.96|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|202.28||||202.28|84.96|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|202.28||||202.28|171.94|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|202.28||||202.28|95.07|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEDICA [2910]|MEDICA HARMONY [291000]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|202.28||||202.28|171.94|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202.28||||202.28|171.94|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|202.28||||202.28|146.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|202.28||||202.28|171.94|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NRECA [1735]|NRECA [173500]|202.28||||202.28|124|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|202.28||||202.28|0|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|202.28||||202.28|171.94|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHCS [1780]|FREEDOM LIFE [178009]|202.28||||202.28|171.94|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHCS [1780]|PHCS MULTIPLAN [178000]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|202.28||||202.28|171.94|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|202.28||||202.28|101.14|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|202.28||||202.28|22.94|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|202.28||||202.28|36.69|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|Self-pay|Self-pay|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS REHAB [1965]|SSA [196500]|202.28||||202.28|115.3|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|202.28||||202.28|115.3|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TML [1980]|TML [198000]|202.28||||202.28|124|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRUSTMARK [2030]|STARMARK [203000]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202.28||||202.28|67.42|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CHEROKEE MLR [203504]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CHOICE [203500]|202.28||||202.28|124|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CORE [203505]|202.28||||202.28|86.57|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR OPTIONS [203501]|202.28||||202.28|147.06|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|202.28||||202.28|124|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|202.28||||202.28||171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202.28||||202.28|124|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|202.28||||202.28|86.57|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|202.28||||202.28|147.06|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|202.28||||202.28|171.94|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WEB TPA [2115]|WEB TPA [211500]|202.28||||202.28|151.71|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WEB TPA [2115]|WEB TPA [211501]|202.28||||202.28|141.59|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|202.28||||202.28|21.85|171.94|21.85
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|202.28||||202.28||171.94|21.85
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|2443.2||||2443.2|1588.08|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2443.2||||2443.2|2076.72|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2443.2||||2443.2|1221.6|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2443.2||||2443.2|443.29|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2443.2||||2443.2|0|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2443.2||||2443.2|1246.03|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|2443.2||||2443.2|1172.74|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2443.2||||2443.2|1392.63|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2443.2||||2443.2|1465.92|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2443.2||||2443.2|1026.15|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CBSA [1215]|CBSA [121500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA PANTEX [126003]|2443.2||||2443.2|1148.31|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA [126008]|2443.2||||2443.2|1773.77|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|2443.2||||2443.2|2076.72|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORESOURCE [1315]|CORESOURCE [131500]|2443.2||||2443.2|1773.77|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EQUITABLE [1355]|EQUITABLE INS [135500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|2443.2||||2443.2|757.39|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|2443.2||||2443.2|277.06|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|2443.2||||2443.2|443.2|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|2443.2||||2443.2|2076.72|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GILSBAR [1425]|GILSBAR [142500]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|2443.2||||2443.2|2076.72|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|2443.2||||2443.2|1221.6|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GUARDIAN [1465]|GUARDIAN [146500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHNET [1495]|HEALTHNET [149500]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2443.2||||2443.2|1773.77|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2443.2||||2443.2|1773.77|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2443.2||||2443.2|1588.08|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|2443.2||||2443.2|855.12|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|2443.2||||2443.2|1026.15|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|2443.2||||2443.2|1026.15|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|2443.2||||2443.2|2076.72|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|2443.2||||2443.2|1148.31|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEDICA [2910]|MEDICA HARMONY [291000]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|2443.2||||2443.2|2076.72|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2443.2||||2443.2|2076.72|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2443.2||||2443.2|1773.77|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2443.2||||2443.2|2076.72|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NRECA [1735]|NRECA [173500]|2443.2||||2443.2|1497.68|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|2443.2||||2443.2|0|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2443.2||||2443.2|2076.72|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|FREEDOM LIFE [178009]|2443.2||||2443.2|2076.72|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2443.2||||2443.2|2076.72|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|2443.2||||2443.2|1221.6|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2443.2||||2443.2|277.06|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|2443.2||||2443.2|443.2|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|Self-pay|Self-pay|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS REHAB [1965]|SSA [196500]|2443.2||||2443.2|1392.63|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|2443.2||||2443.2|1392.63|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TML [1980]|TML [198000]|2443.2||||2443.2|1497.68|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|STARMARK [203000]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2443.2||||2443.2|814.32|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CHEROKEE MLR [203504]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CHOICE [203500]|2443.2||||2443.2|1497.68|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CORE [203505]|2443.2||||2443.2|1045.69|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR OPTIONS [203501]|2443.2||||2443.2|1776.21|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2443.2||||2443.2|1497.68|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|2443.2||||2443.2||2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2443.2||||2443.2|1497.68|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|2443.2||||2443.2|1045.69|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|2443.2||||2443.2|1776.21|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2443.2||||2443.2|2076.72|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WEB TPA [2115]|WEB TPA [211500]|2443.2||||2443.2|1832.4|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WEB TPA [2115]|WEB TPA [211501]|2443.2||||2443.2|1710.24|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|2443.2||||2443.2|263.87|2076.72|263.87
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|2443.2||||2443.2|1588.08|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2443.2||||2443.2|2076.72|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2443.2||||2443.2|1221.6|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2443.2||||2443.2|443.29|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2443.2||||2443.2|0|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2443.2||||2443.2|1246.03|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|2443.2||||2443.2|1172.74|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2443.2||||2443.2|1392.63|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2443.2||||2443.2|1465.92|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2443.2||||2443.2|1026.15|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CBSA [1215]|CBSA [121500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA PANTEX [126003]|2443.2||||2443.2|1148.31|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA [126008]|2443.2||||2443.2|1773.77|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|2443.2||||2443.2|2076.72|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORESOURCE [1315]|CORESOURCE [131500]|2443.2||||2443.2|1773.77|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EQUITABLE [1355]|EQUITABLE INS [135500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|2443.2||||2443.2|757.39|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|2443.2||||2443.2|277.06|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|2443.2||||2443.2|443.2|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|2443.2||||2443.2|2076.72|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GILSBAR [1425]|GILSBAR [142500]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|2443.2||||2443.2|2076.72|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|2443.2||||2443.2|1221.6|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GUARDIAN [1465]|GUARDIAN [146500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHNET [1495]|HEALTHNET [149500]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2443.2||||2443.2|1773.77|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2443.2||||2443.2|1773.77|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2443.2||||2443.2|1588.08|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|2443.2||||2443.2|855.12|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|2443.2||||2443.2|1026.15|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|2443.2||||2443.2|1026.15|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|2443.2||||2443.2|2076.72|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|2443.2||||2443.2|1148.31|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEDICA [2910]|MEDICA HARMONY [291000]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|2443.2||||2443.2|2076.72|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2443.2||||2443.2|2076.72|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2443.2||||2443.2|1773.77|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2443.2||||2443.2|2076.72|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NRECA [1735]|NRECA [173500]|2443.2||||2443.2|1497.68|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|2443.2||||2443.2|0|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2443.2||||2443.2|2076.72|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|FREEDOM LIFE [178009]|2443.2||||2443.2|2076.72|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2443.2||||2443.2|2076.72|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|2443.2||||2443.2|1221.6|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2443.2||||2443.2|277.06|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|2443.2||||2443.2|443.2|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|Self-pay|Self-pay|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS REHAB [1965]|SSA [196500]|2443.2||||2443.2|1392.63|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|2443.2||||2443.2|1392.63|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TML [1980]|TML [198000]|2443.2||||2443.2|1497.68|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|STARMARK [203000]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2443.2||||2443.2|814.32|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CHEROKEE MLR [203504]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CHOICE [203500]|2443.2||||2443.2|1497.68|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CORE [203505]|2443.2||||2443.2|1045.69|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR OPTIONS [203501]|2443.2||||2443.2|1776.21|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2443.2||||2443.2|1497.68|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|2443.2||||2443.2||2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2443.2||||2443.2|1497.68|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|2443.2||||2443.2|1045.69|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|2443.2||||2443.2|1776.21|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2443.2||||2443.2|2076.72|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WEB TPA [2115]|WEB TPA [211500]|2443.2||||2443.2|1832.4|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WEB TPA [2115]|WEB TPA [211501]|2443.2||||2443.2|1710.24|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|2443.2||||2443.2|263.87|2076.72|263.87
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|2443.2||||2443.2|1588.08|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2443.2||||2443.2|2076.72|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2443.2||||2443.2|1221.6|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2443.2||||2443.2|443.29|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2443.2||||2443.2|0|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2443.2||||2443.2|1246.03|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|2443.2||||2443.2|1172.74|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2443.2||||2443.2|1392.63|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2443.2||||2443.2|1465.92|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2443.2||||2443.2|1026.15|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CBSA [1215]|CBSA [121500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA PANTEX [126003]|2443.2||||2443.2|1148.31|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA [126008]|2443.2||||2443.2|1773.77|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|2443.2||||2443.2|2076.72|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORESOURCE [1315]|CORESOURCE [131500]|2443.2||||2443.2|1773.77|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EQUITABLE [1355]|EQUITABLE INS [135500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|2443.2||||2443.2|757.39|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|2443.2||||2443.2|277.06|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|2443.2||||2443.2|443.2|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|2443.2||||2443.2|2076.72|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GILSBAR [1425]|GILSBAR [142500]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|2443.2||||2443.2|2076.72|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|2443.2||||2443.2|1221.6|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GUARDIAN [1465]|GUARDIAN [146500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHNET [1495]|HEALTHNET [149500]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2443.2||||2443.2|1773.77|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2443.2||||2443.2|1773.77|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2443.2||||2443.2|1588.08|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|2443.2||||2443.2|855.12|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|2443.2||||2443.2|1026.15|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|2443.2||||2443.2|1026.15|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|2443.2||||2443.2|2076.72|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|2443.2||||2443.2|1148.31|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEDICA [2910]|MEDICA HARMONY [291000]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|2443.2||||2443.2|2076.72|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2443.2||||2443.2|2076.72|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2443.2||||2443.2|1773.77|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2443.2||||2443.2|2076.72|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NRECA [1735]|NRECA [173500]|2443.2||||2443.2|1497.68|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|2443.2||||2443.2|0|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2443.2||||2443.2|2076.72|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|FREEDOM LIFE [178009]|2443.2||||2443.2|2076.72|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2443.2||||2443.2|2076.72|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|2443.2||||2443.2|1221.6|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2443.2||||2443.2|277.06|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|2443.2||||2443.2|443.2|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|Self-pay|Self-pay|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS REHAB [1965]|SSA [196500]|2443.2||||2443.2|1392.63|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|2443.2||||2443.2|1392.63|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TML [1980]|TML [198000]|2443.2||||2443.2|1497.68|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|STARMARK [203000]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2443.2||||2443.2|814.32|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CHEROKEE MLR [203504]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CHOICE [203500]|2443.2||||2443.2|1497.68|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CORE [203505]|2443.2||||2443.2|1045.69|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR OPTIONS [203501]|2443.2||||2443.2|1776.21|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2443.2||||2443.2|1497.68|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|2443.2||||2443.2||2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2443.2||||2443.2|1497.68|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|2443.2||||2443.2|1045.69|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|2443.2||||2443.2|1776.21|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2443.2||||2443.2|2076.72|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WEB TPA [2115]|WEB TPA [211500]|2443.2||||2443.2|1832.4|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WEB TPA [2115]|WEB TPA [211501]|2443.2||||2443.2|1710.24|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|2443.2||||2443.2|263.87|2076.72|263.87
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2443.2||||2443.2||2076.72|263.87
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|202.28||||202.28|131.48|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202.28||||202.28|171.94|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|202.28||||202.28|101.14|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|202.28||||202.28|36.7|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|202.28||||202.28|0|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|202.28||||202.28|103.16|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|202.28||||202.28|97.09|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|202.28||||202.28|115.3|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|202.28||||202.28|121.37|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202.28||||202.28|84.96|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CBSA [1215]|CBSA [121500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA PANTEX [126003]|202.28||||202.28|0|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA [126008]|202.28||||202.28|146.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|202.28||||202.28|171.94|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CORESOURCE [1315]|CORESOURCE [131500]|202.28||||202.28|146.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|EQUITABLE [1355]|EQUITABLE INS [135500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|202.28||||202.28|62.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|202.28||||202.28|22.94|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|202.28||||202.28|36.69|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|202.28||||202.28|171.94|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GILSBAR [1425]|GILSBAR [142500]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|202.28||||202.28|171.94|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|202.28||||202.28|101.14|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GUARDIAN [1465]|GUARDIAN [146500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHNET [1495]|HEALTHNET [149500]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|202.28||||202.28|146.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202.28||||202.28|146.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|202.28||||202.28|131.48|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|202.28||||202.28|70.8|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|202.28||||202.28|84.96|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|202.28||||202.28|84.96|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|202.28||||202.28|171.94|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|202.28||||202.28|95.07|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEDICA [2910]|MEDICA HARMONY [291000]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|202.28||||202.28|171.94|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202.28||||202.28|171.94|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|202.28||||202.28|146.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|202.28||||202.28|171.94|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NRECA [1735]|NRECA [173500]|202.28||||202.28|124|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|202.28||||202.28|0|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|202.28||||202.28|171.94|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHCS [1780]|FREEDOM LIFE [178009]|202.28||||202.28|171.94|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHCS [1780]|PHCS MULTIPLAN [178000]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|202.28||||202.28|171.94|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|202.28||||202.28|101.14|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|202.28||||202.28|22.94|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|202.28||||202.28|36.69|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|Self-pay|Self-pay|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS REHAB [1965]|SSA [196500]|202.28||||202.28|115.3|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|202.28||||202.28|115.3|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TML [1980]|TML [198000]|202.28||||202.28|124|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRUSTMARK [2030]|STARMARK [203000]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202.28||||202.28|67.42|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CHEROKEE MLR [203504]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CHOICE [203500]|202.28||||202.28|124|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CORE [203505]|202.28||||202.28|86.57|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR OPTIONS [203501]|202.28||||202.28|147.06|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|202.28||||202.28|124|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|202.28||||202.28||171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202.28||||202.28|124|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|202.28||||202.28|86.57|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|202.28||||202.28|147.06|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|202.28||||202.28|171.94|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WEB TPA [2115]|WEB TPA [211500]|202.28||||202.28|151.71|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WEB TPA [2115]|WEB TPA [211501]|202.28||||202.28|141.59|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|202.28||||202.28|21.85|171.94|21.85
10008|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L8 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|202.28||||202.28||171.94|21.85
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|2443.2||||2443.2|1588.08|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2443.2||||2443.2|2076.72|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2443.2||||2443.2|1221.6|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2443.2||||2443.2|443.29|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2443.2||||2443.2|0|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2443.2||||2443.2|1246.03|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|2443.2||||2443.2|1172.74|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2443.2||||2443.2|1392.63|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2443.2||||2443.2|1465.92|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2443.2||||2443.2|1026.15|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CBSA [1215]|CBSA [121500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA PANTEX [126003]|2443.2||||2443.2|1148.31|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA [126008]|2443.2||||2443.2|1773.77|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|2443.2||||2443.2|2076.72|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORESOURCE [1315]|CORESOURCE [131500]|2443.2||||2443.2|1773.77|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EQUITABLE [1355]|EQUITABLE INS [135500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|2443.2||||2443.2|757.39|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|2443.2||||2443.2|277.06|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|2443.2||||2443.2|443.2|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|2443.2||||2443.2|2076.72|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GILSBAR [1425]|GILSBAR [142500]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|2443.2||||2443.2|2076.72|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|2443.2||||2443.2|1221.6|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GUARDIAN [1465]|GUARDIAN [146500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHNET [1495]|HEALTHNET [149500]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2443.2||||2443.2|1773.77|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2443.2||||2443.2|1773.77|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2443.2||||2443.2|1588.08|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|2443.2||||2443.2|855.12|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|2443.2||||2443.2|1026.15|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|2443.2||||2443.2|1026.15|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|2443.2||||2443.2|2076.72|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|2443.2||||2443.2|1148.31|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEDICA [2910]|MEDICA HARMONY [291000]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|2443.2||||2443.2|2076.72|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2443.2||||2443.2|2076.72|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2443.2||||2443.2|1773.77|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2443.2||||2443.2|2076.72|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NRECA [1735]|NRECA [173500]|2443.2||||2443.2|1497.68|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|2443.2||||2443.2|0|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2443.2||||2443.2|2076.72|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|FREEDOM LIFE [178009]|2443.2||||2443.2|2076.72|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2443.2||||2443.2|2076.72|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|2443.2||||2443.2|1221.6|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2443.2||||2443.2|277.06|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|2443.2||||2443.2|443.2|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|Self-pay|Self-pay|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS REHAB [1965]|SSA [196500]|2443.2||||2443.2|1392.63|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|2443.2||||2443.2|1392.63|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TML [1980]|TML [198000]|2443.2||||2443.2|1497.68|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|STARMARK [203000]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2443.2||||2443.2|814.32|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CHEROKEE MLR [203504]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CHOICE [203500]|2443.2||||2443.2|1497.68|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CORE [203505]|2443.2||||2443.2|1045.69|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR OPTIONS [203501]|2443.2||||2443.2|1776.21|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2443.2||||2443.2|1497.68|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|2443.2||||2443.2||2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2443.2||||2443.2|1497.68|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|2443.2||||2443.2|1045.69|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|2443.2||||2443.2|1776.21|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2443.2||||2443.2|2076.72|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WEB TPA [2115]|WEB TPA [211500]|2443.2||||2443.2|1832.4|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WEB TPA [2115]|WEB TPA [211501]|2443.2||||2443.2|1710.24|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|2443.2||||2443.2|263.87|2076.72|263.87
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|2443.2||||2443.2|1588.08|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2443.2||||2443.2|2076.72|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2443.2||||2443.2|1221.6|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2443.2||||2443.2|443.29|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2443.2||||2443.2|0|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2443.2||||2443.2|1246.03|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|2443.2||||2443.2|1172.74|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2443.2||||2443.2|1392.63|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2443.2||||2443.2|1465.92|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2443.2||||2443.2|1026.15|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CBSA [1215]|CBSA [121500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA PANTEX [126003]|2443.2||||2443.2|1148.31|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA [126008]|2443.2||||2443.2|1773.77|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|2443.2||||2443.2|2076.72|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORESOURCE [1315]|CORESOURCE [131500]|2443.2||||2443.2|1773.77|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EQUITABLE [1355]|EQUITABLE INS [135500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|2443.2||||2443.2|757.39|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|2443.2||||2443.2|277.06|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|2443.2||||2443.2|443.2|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|2443.2||||2443.2|2076.72|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GILSBAR [1425]|GILSBAR [142500]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|2443.2||||2443.2|2076.72|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|2443.2||||2443.2|1221.6|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GUARDIAN [1465]|GUARDIAN [146500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHNET [1495]|HEALTHNET [149500]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2443.2||||2443.2|1773.77|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2443.2||||2443.2|1773.77|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2443.2||||2443.2|1588.08|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|2443.2||||2443.2|855.12|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|2443.2||||2443.2|1026.15|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|2443.2||||2443.2|1026.15|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|2443.2||||2443.2|2076.72|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|2443.2||||2443.2|1148.31|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEDICA [2910]|MEDICA HARMONY [291000]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|2443.2||||2443.2|2076.72|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2443.2||||2443.2|2076.72|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2443.2||||2443.2|1773.77|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2443.2||||2443.2|2076.72|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NRECA [1735]|NRECA [173500]|2443.2||||2443.2|1497.68|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|2443.2||||2443.2|0|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2443.2||||2443.2|2076.72|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|FREEDOM LIFE [178009]|2443.2||||2443.2|2076.72|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2443.2||||2443.2|2076.72|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|2443.2||||2443.2|1221.6|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2443.2||||2443.2|277.06|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|2443.2||||2443.2|443.2|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|Self-pay|Self-pay|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS REHAB [1965]|SSA [196500]|2443.2||||2443.2|1392.63|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|2443.2||||2443.2|1392.63|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TML [1980]|TML [198000]|2443.2||||2443.2|1497.68|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|STARMARK [203000]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2443.2||||2443.2|814.32|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CHEROKEE MLR [203504]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CHOICE [203500]|2443.2||||2443.2|1497.68|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CORE [203505]|2443.2||||2443.2|1045.69|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR OPTIONS [203501]|2443.2||||2443.2|1776.21|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2443.2||||2443.2|1497.68|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|2443.2||||2443.2||2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2443.2||||2443.2|1497.68|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|2443.2||||2443.2|1045.69|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|2443.2||||2443.2|1776.21|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2443.2||||2443.2|2076.72|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WEB TPA [2115]|WEB TPA [211500]|2443.2||||2443.2|1832.4|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WEB TPA [2115]|WEB TPA [211501]|2443.2||||2443.2|1710.24|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|2443.2||||2443.2|263.87|2076.72|263.87
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|2443.2||||2443.2|1588.08|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2443.2||||2443.2|2076.72|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2443.2||||2443.2|1221.6|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2443.2||||2443.2|443.29|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2443.2||||2443.2|0|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2443.2||||2443.2|1246.03|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|2443.2||||2443.2|1172.74|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2443.2||||2443.2|1392.63|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2443.2||||2443.2|1465.92|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2443.2||||2443.2|1026.15|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CBSA [1215]|CBSA [121500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA PANTEX [126003]|2443.2||||2443.2|1148.31|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA [126008]|2443.2||||2443.2|1773.77|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|2443.2||||2443.2|2076.72|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORESOURCE [1315]|CORESOURCE [131500]|2443.2||||2443.2|1773.77|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EQUITABLE [1355]|EQUITABLE INS [135500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|2443.2||||2443.2|757.39|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|2443.2||||2443.2|277.06|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|2443.2||||2443.2|443.2|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|2443.2||||2443.2|2076.72|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GILSBAR [1425]|GILSBAR [142500]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|2443.2||||2443.2|2076.72|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|2443.2||||2443.2|1221.6|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GUARDIAN [1465]|GUARDIAN [146500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHNET [1495]|HEALTHNET [149500]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2443.2||||2443.2|1773.77|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2443.2||||2443.2|1773.77|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2443.2||||2443.2|1588.08|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|2443.2||||2443.2|855.12|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|2443.2||||2443.2|1026.15|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|2443.2||||2443.2|1026.15|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|2443.2||||2443.2|2076.72|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|2443.2||||2443.2|1148.31|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEDICA [2910]|MEDICA HARMONY [291000]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|2443.2||||2443.2|2076.72|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2443.2||||2443.2|2076.72|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2443.2||||2443.2|1773.77|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2443.2||||2443.2|2076.72|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NRECA [1735]|NRECA [173500]|2443.2||||2443.2|1497.68|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|2443.2||||2443.2|0|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2443.2||||2443.2|2076.72|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|FREEDOM LIFE [178009]|2443.2||||2443.2|2076.72|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2443.2||||2443.2|2076.72|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|2443.2||||2443.2|1221.6|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2443.2||||2443.2|277.06|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|2443.2||||2443.2|443.2|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|Self-pay|Self-pay|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS REHAB [1965]|SSA [196500]|2443.2||||2443.2|1392.63|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|2443.2||||2443.2|1392.63|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TML [1980]|TML [198000]|2443.2||||2443.2|1497.68|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|STARMARK [203000]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2443.2||||2443.2|814.32|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CHEROKEE MLR [203504]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CHOICE [203500]|2443.2||||2443.2|1497.68|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR CORE [203505]|2443.2||||2443.2|1045.69|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR OPTIONS [203501]|2443.2||||2443.2|1776.21|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2443.2||||2443.2|1497.68|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|2443.2||||2443.2||2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2443.2||||2443.2|1497.68|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|2443.2||||2443.2|1045.69|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|2443.2||||2443.2|1776.21|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2443.2||||2443.2|2076.72|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WEB TPA [2115]|WEB TPA [211500]|2443.2||||2443.2|1832.4|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WEB TPA [2115]|WEB TPA [211501]|2443.2||||2443.2|1710.24|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|2443.2||||2443.2|263.87|2076.72|263.87
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2443.2||||2443.2||2076.72|263.87
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|202.28||||202.28|131.48|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202.28||||202.28|171.94|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|202.28||||202.28|101.14|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|202.28||||202.28|36.7|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|202.28||||202.28|0|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|202.28||||202.28|103.16|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|202.28||||202.28|97.09|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|202.28||||202.28|115.3|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|202.28||||202.28|121.37|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202.28||||202.28|84.96|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CBSA [1215]|CBSA [121500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA PANTEX [126003]|202.28||||202.28|0|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA [126008]|202.28||||202.28|146.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|202.28||||202.28|171.94|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CORESOURCE [1315]|CORESOURCE [131500]|202.28||||202.28|146.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|EQUITABLE [1355]|EQUITABLE INS [135500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|202.28||||202.28|62.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|202.28||||202.28|22.94|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|202.28||||202.28|36.69|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|202.28||||202.28|171.94|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GILSBAR [1425]|GILSBAR [142500]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|202.28||||202.28|171.94|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|202.28||||202.28|101.14|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GUARDIAN [1465]|GUARDIAN [146500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHNET [1495]|HEALTHNET [149500]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|202.28||||202.28|146.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202.28||||202.28|146.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|202.28||||202.28|131.48|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|202.28||||202.28|70.8|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|202.28||||202.28|84.96|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|202.28||||202.28|84.96|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|202.28||||202.28|171.94|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|202.28||||202.28|95.07|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEDICA [2910]|MEDICA HARMONY [291000]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|202.28||||202.28|171.94|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202.28||||202.28|171.94|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|202.28||||202.28|146.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|202.28||||202.28|171.94|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NRECA [1735]|NRECA [173500]|202.28||||202.28|124|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|202.28||||202.28|0|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|202.28||||202.28|171.94|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHCS [1780]|FREEDOM LIFE [178009]|202.28||||202.28|171.94|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHCS [1780]|PHCS MULTIPLAN [178000]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|202.28||||202.28|171.94|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|202.28||||202.28|101.14|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|202.28||||202.28|22.94|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|202.28||||202.28|36.69|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|Self-pay|Self-pay|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS REHAB [1965]|SSA [196500]|202.28||||202.28|115.3|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|202.28||||202.28|115.3|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TML [1980]|TML [198000]|202.28||||202.28|124|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRUSTMARK [2030]|STARMARK [203000]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202.28||||202.28|67.42|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CHEROKEE MLR [203504]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CHOICE [203500]|202.28||||202.28|124|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CORE [203505]|202.28||||202.28|86.57|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR OPTIONS [203501]|202.28||||202.28|147.06|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|202.28||||202.28|124|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|202.28||||202.28||171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202.28||||202.28|124|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|202.28||||202.28|86.57|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|202.28||||202.28|147.06|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|202.28||||202.28|171.94|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WEB TPA [2115]|WEB TPA [211500]|202.28||||202.28|151.71|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WEB TPA [2115]|WEB TPA [211501]|202.28||||202.28|141.59|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|202.28||||202.28|21.85|171.94|21.85
10009|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L9 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|202.28||||202.28||171.94|21.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|7.85||||7.85|5.1|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7.85||||7.85|6.67|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|7.85||||7.85|3.93|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.85||||7.85|1.42|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|7.85||||7.85|0|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|7.85||||7.85|4|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|7.85||||7.85|3.77|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|7.85||||7.85|4.48|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|7.85||||7.85|4.71|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7.85||||7.85|3.3|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CBSA [1215]|CBSA [121500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CIGNA [1260]|CIGNA PANTEX [126003]|7.85||||7.85|3.69|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CIGNA [1260]|CIGNA [126008]|7.85||||7.85|5.7|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|7.85||||7.85|6.67|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|7.85||||7.85|5.7|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|EQUITABLE [1355]|EQUITABLE INS [135500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|7.85||||7.85|2.43|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|7.85||||7.85|0.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|7.85||||7.85|1.42|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|7.85||||7.85|6.67|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|GILSBAR [1425]|GILSBAR [142500]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|7.85||||7.85|6.67|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|7.85||||7.85|3.93|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|GUARDIAN [1465]|GUARDIAN [146500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7.85||||7.85|5.7|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.85||||7.85|5.7|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.85||||7.85|3.93|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|7.85||||7.85|2.75|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|7.85||||7.85|3.3|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|7.85||||7.85|3.3|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|7.85||||7.85|6.67|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|7.85||||7.85|3.69|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MEDICA [2910]|MEDICA HARMONY [291000]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|7.85||||7.85|6.67|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7.85||||7.85|6.67|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|7.85||||7.85|5.7|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|7.85||||7.85|6.67|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|NRECA [1735]|NRECA [173500]|7.85||||7.85|4.81|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|7.85||||7.85|0|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7.85||||7.85|6.67|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PHCS [1780]|FREEDOM LIFE [178009]|7.85||||7.85|6.67|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|7.85||||7.85|6.67|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|7.85||||7.85|3.93|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|7.85||||7.85|0.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|7.85||||7.85|1.42|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|Self-pay|Self-pay|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|TEXAS REHAB [1965]|SSA [196500]|7.85||||7.85|4.48|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|7.85||||7.85|4.48|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|TML [1980]|TML [198000]|7.85||||7.85|4.81|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|TRUSTMARK [2030]|STARMARK [203000]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.85||||7.85|2.62|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UMR [2035]|UMR CHEROKEE MLR [203504]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UMR [2035]|UMR CHOICE [203500]|7.85||||7.85|4.81|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UMR [2035]|UMR CORE [203505]|7.85||||7.85|3.36|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UMR [2035]|UMR OPTIONS [203501]|7.85||||7.85|5.71|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|7.85||||7.85|4.81|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|7.85||||7.85||6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|7.85||||7.85|4.81|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|7.85||||7.85|3.36|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|7.85||||7.85|5.71|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.85||||7.85|6.67|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|WEB TPA [2115]|WEB TPA [211500]|7.85||||7.85|5.89|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|WEB TPA [2115]|WEB TPA [211501]|7.85||||7.85|5.5|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|7.85||||7.85|0.85|6.67|0.85
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|7.85||||7.85||6.67|0.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|792||||792|514.8|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|792||||792|673.2|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|792||||792|396|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|792||||792|143.7|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|792||||792|0|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|792||||792|403.92|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|792||||792|380.16|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|792||||792|451.44|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|792||||792|475.2|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|792||||792|332.64|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CBSA [1215]|CBSA [121500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CELTIC LIFE [1220]|CELTIC LIFE [122000]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CIGNA [1260]|CIGNA PANTEX [126003]|792||||792|372.24|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CIGNA [1260]|CIGNA [126008]|792||||792|574.99|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|792||||792|673.2|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|792||||792|574.99|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|EQUITABLE [1355]|EQUITABLE INS [135500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|792||||792|245.52|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|792||||792|89.81|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|792||||792|143.67|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|792||||792|673.2|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|GILSBAR [1425]|GILSBAR [142500]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|GROUP HEALTH [2165]|GROUP HEALTH [216500]|792||||792|673.2|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|792||||792|396|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|GUARDIAN [1465]|GUARDIAN [146500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|792||||792|574.99|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|792||||792|574.99|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|792||||792|396|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|792||||792|277.2|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|792||||792|332.64|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|792||||792|332.64|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|792||||792|673.2|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|LEWER AGENCY [1565]|LEWER AGENCY [156500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|792||||792|372.24|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MEDICA [2910]|MEDICA HARMONY [291000]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|792||||792|673.2|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|792||||792|673.2|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|792||||792|574.99|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|792||||792|673.2|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|NRECA [1735]|NRECA [173500]|792||||792|485.5|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|792||||792|0|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|792||||792|673.2|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PHCS [1780]|FREEDOM LIFE [178009]|792||||792|673.2|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PHCS [1780]|PHCS MULTIPLAN [178000]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|792||||792|673.2|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|SANA BENEFITS [5005]|SANA BENEFITS [500500]|792||||792|396|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|792||||792|89.81|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|792||||792|143.67|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|Self-pay|Self-pay|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|TEXAS REHAB [1965]|SSA [196500]|792||||792|451.44|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|792||||792|451.44|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|TML [1980]|TML [198000]|792||||792|485.5|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|TRUSTMARK [2030]|STARMARK [203000]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|792||||792|263.97|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UMR [2035]|UMR CHEROKEE MLR [203504]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UMR [2035]|UMR CHOICE [203500]|792||||792|485.5|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UMR [2035]|UMR CORE [203505]|792||||792|338.98|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UMR [2035]|UMR OPTIONS [203501]|792||||792|575.78|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|792||||792|485.5|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|792||||792||673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|792||||792|485.5|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|792||||792|338.98|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|792||||792|575.78|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|792||||792|673.2|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|WEB TPA [2115]|WEB TPA [211500]|792||||792|594|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|WEB TPA [2115]|WEB TPA [211501]|792||||792|554.4|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|792||||792|85.54|673.2|21.85
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|792||||792||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|202.28||||202.28|131.48|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202.28||||202.28|171.94|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|202.28||||202.28|101.14|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|202.28||||202.28|36.7|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|202.28||||202.28|0|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|202.28||||202.28|103.16|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|202.28||||202.28|97.09|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|202.28||||202.28|115.3|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|202.28||||202.28|121.37|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202.28||||202.28|84.96|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CBSA [1215]|CBSA [121500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA PANTEX [126003]|202.28||||202.28|0|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA [126008]|202.28||||202.28|146.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|202.28||||202.28|171.94|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CORESOURCE [1315]|CORESOURCE [131500]|202.28||||202.28|146.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|EQUITABLE [1355]|EQUITABLE INS [135500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|202.28||||202.28|62.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|202.28||||202.28|22.94|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|202.28||||202.28|36.69|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|202.28||||202.28|171.94|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GILSBAR [1425]|GILSBAR [142500]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|202.28||||202.28|171.94|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|202.28||||202.28|101.14|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GUARDIAN [1465]|GUARDIAN [146500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHNET [1495]|HEALTHNET [149500]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|202.28||||202.28|146.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202.28||||202.28|146.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|202.28||||202.28|131.48|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|202.28||||202.28|70.8|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|202.28||||202.28|84.96|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|202.28||||202.28|84.96|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|202.28||||202.28|171.94|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|202.28||||202.28|95.07|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEDICA [2910]|MEDICA HARMONY [291000]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|202.28||||202.28|171.94|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202.28||||202.28|171.94|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|202.28||||202.28|146.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|202.28||||202.28|171.94|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NRECA [1735]|NRECA [173500]|202.28||||202.28|124|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|202.28||||202.28|0|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|202.28||||202.28|171.94|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHCS [1780]|FREEDOM LIFE [178009]|202.28||||202.28|171.94|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHCS [1780]|PHCS MULTIPLAN [178000]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|202.28||||202.28|171.94|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|202.28||||202.28|101.14|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|202.28||||202.28|22.94|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|202.28||||202.28|36.69|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|Self-pay|Self-pay|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS REHAB [1965]|SSA [196500]|202.28||||202.28|115.3|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|202.28||||202.28|115.3|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TML [1980]|TML [198000]|202.28||||202.28|124|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRUSTMARK [2030]|STARMARK [203000]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202.28||||202.28|67.42|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CHEROKEE MLR [203504]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CHOICE [203500]|202.28||||202.28|124|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR CORE [203505]|202.28||||202.28|86.57|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR OPTIONS [203501]|202.28||||202.28|147.06|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|202.28||||202.28|124|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|202.28||||202.28||673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|202.28||||202.28|124|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|202.28||||202.28|86.57|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|202.28||||202.28|147.06|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|202.28||||202.28|171.94|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WEB TPA [2115]|WEB TPA [211500]|202.28||||202.28|151.71|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WEB TPA [2115]|WEB TPA [211501]|202.28||||202.28|141.59|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|202.28||||202.28|21.85|673.2|21.85
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|202.28||||202.28||673.2|21.85
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|1582.73||||1582.73|1028.78|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1582.73||||1582.73|1345.32|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1582.73||||1582.73|791.37|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1582.73||||1582.73|287.17|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1582.73||||1582.73|0|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1582.73||||1582.73|807.19|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1582.73||||1582.73|759.71|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1582.73||||1582.73|902.16|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1582.73||||1582.73|949.64|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1582.73||||1582.73|664.75|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|CBSA [1215]|CBSA [121500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|CIGNA [1260]|CIGNA PANTEX [126003]|1582.73||||1582.73|743.88|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|CIGNA [1260]|CIGNA [126008]|1582.73||||1582.73|1149.06|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1582.73||||1582.73|1345.32|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|CORESOURCE [1315]|CORESOURCE [131500]|1582.73||||1582.73|1149.06|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|EQUITABLE [1355]|EQUITABLE INS [135500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|1582.73||||1582.73|490.65|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1582.73||||1582.73|179.48|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|1582.73||||1582.73|287.11|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1582.73||||1582.73|1345.32|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|GILSBAR [1425]|GILSBAR [142500]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1582.73||||1582.73|1345.32|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1582.73||||1582.73|791.37|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|GUARDIAN [1465]|GUARDIAN [146500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|HEALTHNET [1495]|HEALTHNET [149500]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1582.73||||1582.73|1149.06|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1582.73||||1582.73|1149.06|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1582.73||||1582.73|1028.78|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1582.73||||1582.73|553.96|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1582.73||||1582.73|664.75|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1582.73||||1582.73|664.75|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1582.73||||1582.73|1345.32|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1582.73||||1582.73|743.88|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|MEDICA [2910]|MEDICA HARMONY [291000]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1582.73||||1582.73|1345.32|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1582.73||||1582.73|1345.32|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1582.73||||1582.73|1149.06|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1582.73||||1582.73|1345.32|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|NRECA [1735]|NRECA [173500]|1582.73||||1582.73|970.21|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1582.73||||1582.73|0|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1582.73||||1582.73|1345.32|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|PHCS [1780]|FREEDOM LIFE [178009]|1582.73||||1582.73|1345.32|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1582.73||||1582.73|1345.32|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|1582.73||||1582.73|791.37|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1582.73||||1582.73|179.48|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|1582.73||||1582.73|287.11|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|Self-pay|Self-pay|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|TEXAS REHAB [1965]|SSA [196500]|1582.73||||1582.73|902.16|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1582.73||||1582.73|902.16|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|TML [1980]|TML [198000]|1582.73||||1582.73|970.21|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|TRUSTMARK [2030]|STARMARK [203000]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1582.73||||1582.73|527.52|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UMR [2035]|UMR CHEROKEE MLR [203504]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UMR [2035]|UMR CHOICE [203500]|1582.73||||1582.73|970.21|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UMR [2035]|UMR CORE [203505]|1582.73||||1582.73|677.41|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UMR [2035]|UMR OPTIONS [203501]|1582.73||||1582.73|1150.65|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1582.73||||1582.73|970.21|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1582.73||||1582.73||1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1582.73||||1582.73|970.21|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1582.73||||1582.73|677.41|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1582.73||||1582.73|1150.65|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1582.73||||1582.73|1345.32|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|WEB TPA [2115]|WEB TPA [211500]|1582.73||||1582.73|1187.05|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|WEB TPA [2115]|WEB TPA [211501]|1582.73||||1582.73|1107.91|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|1582.73||||1582.73|170.94|1345.32|170.94
100105|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE CORKSCREW BIOCOMPOSITE FULL THREAD L4.75 MR TAPE STERILE LATEX FREE DISPOSABLE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|1582.73||||1582.73||1345.32|170.94
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|1072.23||||1072.23|696.95|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1072.23||||1072.23|911.39|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1072.23||||1072.23|536.11|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1072.23||||1072.23|194.54|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1072.23||||1072.23|0|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1072.23||||1072.23|546.83|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1072.23||||1072.23|514.67|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1072.23||||1072.23|611.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1072.23||||1072.23|643.34|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1072.23||||1072.23|450.33|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CBSA [1215]|CBSA [121500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CIGNA [1260]|CIGNA PANTEX [126003]|1072.23||||1072.23|503.95|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CIGNA [1260]|CIGNA [126008]|1072.23||||1072.23|778.44|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1072.23||||1072.23|911.39|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CORESOURCE [1315]|CORESOURCE [131500]|1072.23||||1072.23|778.44|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|EQUITABLE [1355]|EQUITABLE INS [135500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|1072.23||||1072.23|332.39|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1072.23||||1072.23|121.59|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|1072.23||||1072.23|194.5|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1072.23||||1072.23|911.39|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|GILSBAR [1425]|GILSBAR [142500]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1072.23||||1072.23|911.39|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1072.23||||1072.23|536.11|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|GUARDIAN [1465]|GUARDIAN [146500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|HEALTHNET [1495]|HEALTHNET [149500]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1072.23||||1072.23|778.44|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1072.23||||1072.23|778.44|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1072.23||||1072.23|536.11|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1072.23||||1072.23|375.28|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1072.23||||1072.23|450.33|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1072.23||||1072.23|450.33|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1072.23||||1072.23|911.39|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1072.23||||1072.23|503.95|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MEDICA [2910]|MEDICA HARMONY [291000]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1072.23||||1072.23|911.39|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1072.23||||1072.23|911.39|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1072.23||||1072.23|778.44|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1072.23||||1072.23|911.39|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|NRECA [1735]|NRECA [173500]|1072.23||||1072.23|657.27|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1072.23||||1072.23|0|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1072.23||||1072.23|911.39|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|PHCS [1780]|FREEDOM LIFE [178009]|1072.23||||1072.23|911.39|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|PHCS [1780]|PHCS MULTIPLAN [178000]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1072.23||||1072.23|911.39|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|1072.23||||1072.23|536.11|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1072.23||||1072.23|121.59|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|1072.23||||1072.23|194.5|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|Self-pay|Self-pay|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|TEXAS REHAB [1965]|SSA [196500]|1072.23||||1072.23|611.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1072.23||||1072.23|611.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|TML [1980]|TML [198000]|1072.23||||1072.23|657.27|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|TRUSTMARK [2030]|STARMARK [203000]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1072.23||||1072.23|357.37|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UMR [2035]|UMR CHEROKEE MLR [203504]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UMR [2035]|UMR CHOICE [203500]|1072.23||||1072.23|657.27|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UMR [2035]|UMR CORE [203505]|1072.23||||1072.23|458.91|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UMR [2035]|UMR OPTIONS [203501]|1072.23||||1072.23|779.51|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1072.23||||1072.23|657.27|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1072.23||||1072.23||911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1072.23||||1072.23|657.27|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1072.23||||1072.23|458.91|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1072.23||||1072.23|779.51|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1072.23||||1072.23|911.39|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|WEB TPA [2115]|WEB TPA [211500]|1072.23||||1072.23|804.17|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|WEB TPA [2115]|WEB TPA [211501]|1072.23||||1072.23|750.56|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|1072.23||||1072.23|115.8|911.39|115.8
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|1072.23||||1072.23||911.39|115.8
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|3098.59||||3098.59|2014.08|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3098.59||||3098.59|2633.8|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|3098.59||||3098.59|1549.29|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3098.59||||3098.59|562.21|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|3098.59||||3098.59|0|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|3098.59||||3098.59|1580.28|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|3098.59||||3098.59|1487.32|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|3098.59||||3098.59|1766.2|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|3098.59||||3098.59|1859.15|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3098.59||||3098.59|1301.41|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|CBSA [1215]|CBSA [121500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|CIGNA [1260]|CIGNA PANTEX [126003]|3098.59||||3098.59|1456.34|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|CIGNA [1260]|CIGNA [126008]|3098.59||||3098.59|2249.57|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|3098.59||||3098.59|2633.8|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|CORESOURCE [1315]|CORESOURCE [131500]|3098.59||||3098.59|2249.57|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|EQUITABLE [1355]|EQUITABLE INS [135500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|3098.59||||3098.59|960.56|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|3098.59||||3098.59|351.38|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|3098.59||||3098.59|562.08|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|3098.59||||3098.59|2633.8|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|GILSBAR [1425]|GILSBAR [142500]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|3098.59||||3098.59|2633.8|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|3098.59||||3098.59|1549.29|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|GUARDIAN [1465]|GUARDIAN [146500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|HEALTHNET [1495]|HEALTHNET [149500]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|3098.59||||3098.59|2249.57|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3098.59||||3098.59|2249.57|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3098.59||||3098.59|2014.08|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|3098.59||||3098.59|1084.51|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|3098.59||||3098.59|1301.41|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|3098.59||||3098.59|1301.41|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|3098.59||||3098.59|2633.8|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|3098.59||||3098.59|1456.34|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|MEDICA [2910]|MEDICA HARMONY [291000]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|3098.59||||3098.59|2633.8|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3098.59||||3098.59|2633.8|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|3098.59||||3098.59|2249.57|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|3098.59||||3098.59|2633.8|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|NRECA [1735]|NRECA [173500]|3098.59||||3098.59|1899.43|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|3098.59||||3098.59|0|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|3098.59||||3098.59|2633.8|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|PHCS [1780]|FREEDOM LIFE [178009]|3098.59||||3098.59|2633.8|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|3098.59||||3098.59|2633.8|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|3098.59||||3098.59|1549.29|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|3098.59||||3098.59|351.38|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|3098.59||||3098.59|562.08|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|Self-pay|Self-pay|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|TEXAS REHAB [1965]|SSA [196500]|3098.59||||3098.59|1766.2|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|3098.59||||3098.59|1766.2|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|TML [1980]|TML [198000]|3098.59||||3098.59|1899.43|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|TRUSTMARK [2030]|STARMARK [203000]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3098.59||||3098.59|1032.76|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UMR [2035]|UMR CHEROKEE MLR [203504]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UMR [2035]|UMR CHOICE [203500]|3098.59||||3098.59|1899.43|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UMR [2035]|UMR CORE [203505]|3098.59||||3098.59|1326.2|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UMR [2035]|UMR OPTIONS [203501]|3098.59||||3098.59|2252.67|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|3098.59||||3098.59|1899.43|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|3098.59||||3098.59||2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3098.59||||3098.59|1899.43|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|3098.59||||3098.59|1326.2|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|3098.59||||3098.59|2252.67|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3098.59||||3098.59|2633.8|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|WEB TPA [2115]|WEB TPA [211500]|3098.59||||3098.59|2323.94|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|WEB TPA [2115]|WEB TPA [211501]|3098.59||||3098.59|2169.01|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|3098.59||||3098.59|334.65|2633.8|334.65
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|3098.59||||3098.59||2633.8|334.65
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|111.71||||111.71|72.61|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111.71||||111.71|94.95|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|111.71||||111.71|55.85|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|111.71||||111.71|20.27|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|111.71||||111.71|0|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|111.71||||111.71|56.97|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|111.71||||111.71|53.62|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|111.71||||111.71|63.67|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|111.71||||111.71|67.02|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111.71||||111.71|46.92|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CBSA [1215]|CBSA [121500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CELTIC LIFE [1220]|CELTIC LIFE [122000]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CIGNA [1260]|CIGNA PANTEX [126003]|111.71||||111.71|52.5|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CIGNA [1260]|CIGNA [126008]|111.71||||111.71|81.1|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|111.71||||111.71|94.95|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CORESOURCE [1315]|CORESOURCE [131500]|111.71||||111.71|81.1|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CORVEL CORP [2235]|CORVEL CORP [223500]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|EQUITABLE [1355]|EQUITABLE INS [135500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|111.71||||111.71|34.63|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|111.71||||111.71|12.67|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|111.71||||111.71|20.26|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|111.71||||111.71|94.95|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|GILSBAR [1425]|GILSBAR [142500]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|GROUP HEALTH [2165]|GROUP HEALTH [216500]|111.71||||111.71|94.95|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|111.71||||111.71|55.85|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|GUARDIAN [1465]|GUARDIAN [146500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|HEALTHNET [1495]|HEALTHNET [149500]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|111.71||||111.71|81.1|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111.71||||111.71|81.1|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|111.71||||111.71|55.85|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|111.71||||111.71|39.1|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|111.71||||111.71|46.92|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|111.71||||111.71|46.92|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|111.71||||111.71|94.95|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|LEWER AGENCY [1565]|LEWER AGENCY [156500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|111.71||||111.71|52.5|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|MEDICA [2910]|MEDICA HARMONY [291000]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|111.71||||111.71|94.95|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111.71||||111.71|94.95|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|111.71||||111.71|81.1|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|111.71||||111.71|94.95|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|NRECA [1735]|NRECA [173500]|111.71||||111.71|68.48|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|111.71||||111.71|0|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|111.71||||111.71|94.95|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|PEAK PACE SOLUTIONS MEDICAID [3715]|PEAK PACE SOLUTIONS MEDICAID [371500]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|PHCS [1780]|FREEDOM LIFE [178009]|111.71||||111.71|94.95|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|PHCS [1780]|PHCS MULTIPLAN [178000]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|111.71||||111.71|94.95|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|SANA BENEFITS [5005]|SANA BENEFITS [500500]|111.71||||111.71|55.85|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|SCOTT AND WHITE MEDICAID REPLACEMENT [3730]|SCOTT AND WHITE HEALTH PLAN RIGHT CARE [373002]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|111.71||||111.71|12.67|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR STAR MEDICAID [194500]|111.71||||111.71|20.26|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|Self-pay|Self-pay|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|TEXAS CHILDRENS HEALTH PLAN [3995]|TEXAS CHILDRENS HEALTH PLAN [399500]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|TEXAS REHAB [1965]|SSA [196500]|111.71||||111.71|63.67|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|111.71||||111.71|63.67|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|TML [1980]|TML [198000]|111.71||||111.71|68.48|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|TRUSTMARK [2030]|STARMARK [203000]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111.71||||111.71|37.23|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UMR [2035]|UMR CHEROKEE MLR [203504]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UMR [2035]|UMR CHOICE [203500]|111.71||||111.71|68.48|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UMR [2035]|UMR CORE [203505]|111.71||||111.71|47.81|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UMR [2035]|UMR OPTIONS [203501]|111.71||||111.71|81.21|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|111.71||||111.71|68.48|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|111.71||||111.71||94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|111.71||||111.71|68.48|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|111.71||||111.71|47.81|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|111.71||||111.71|81.21|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|111.71||||111.71|94.95|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|WEB TPA [2115]|WEB TPA [211500]|111.71||||111.71|83.78|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|WEB TPA [2115]|WEB TPA [211501]|111.71||||111.71|78.19|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|111.71||||111.71|12.06|94.95|12.06
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|111.71||||111.71||94.95|12.06
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1.44||||1.44|0.16|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA CLIENT SPECIFIC [101506]|1.44||||1.44|0.94|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.26|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44|0|171.94|0.16
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]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|90 DEGREE BENEFITS TSHB [120006]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|1.44||||1.44|0.16|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|1.44||||1.44|0.16|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FIRST CARE COMMERCIAL [1371]|FIRSTCARE HMO [137103]|1.44||||1.44|0.45|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.16|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FIRST CARE MEDICAID [1372]|FIRSTCARE STAR MEDICAID [137201]|1.44||||1.44|0.26|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|1.44||||1.44|0.16|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|1.44||||1.44|0.16|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44||171.94|0.16
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]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.16|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1.44||||1.44|1.08|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44||171.94|0.16
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]|1.44||||1.44|0.16|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44||171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44|0|171.94|0.16
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]|1.44||||1.44|1.01|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|171.94|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLE