"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|AARP [1000]|AARP [100000]|2725.2||||2725.2|1362.6|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2725.2||||2725.2||1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA [101529]|2725.2||||2725.2|1883.11|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AMBETTER [2930]|AMBETTER [293000]|2725.2||||2725.2||1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2725.2||||2725.2|736.62|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2725.2||||2725.2||1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|2725.2||||2725.2|1280.84|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2725.2||||2725.2|736.62|1962.14|463.28
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]|2725.2||||2725.2||1962.14|463.28
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]|2725.2||||2725.2|1962.14|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|2725.2||||2725.2|1635.12|1962.14|463.28
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]|2725.2||||2725.2|1907.64|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2725.2||||2725.2|1662.37|1962.14|463.28
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]|2725.2||||2725.2|736.62|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2725.2||||2725.2||1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2725.2||||2725.2|1880.39|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CIGNA [1260]|CIGNA PPO [126025]|2725.2||||2725.2|1635.12|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2725.2||||2725.2|1362.6|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|2725.2||||2725.2|1880.39|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|2725.2||||2725.2|1280.84|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2725.2||||2725.2|1880.39|1962.14|463.28
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]|2725.2||||2725.2||1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2725.2||||2725.2|1883.11|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2725.2||||2725.2|736.62|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2725.2||||2725.2||1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2725.2||||2725.2|1883.11|1962.14|463.28
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]|2725.2||||2725.2|736.62|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2725.2||||2725.2|1880.39|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2725.2||||2725.2|736.62|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|Self-pay|Self-pay|2725.2||||2725.2|545.04|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|TML [1980]|TML [198000]|2725.2||||2725.2|1880.39|1962.14|463.28
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]|2725.2||||2725.2|463.28|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|2725.2||||2725.2|1362.6|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UNICARE [2040]|UNICARE [204000]|2725.2||||2725.2|1362.6|1962.14|463.28
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]|2725.2||||2725.2||1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2725.2||||2725.2|1362.6|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|WEB TPA [2115]|WEB TPA [211500]|2725.2||||2725.2|1880.39|1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|2725.2||||2725.2||1962.14|463.28
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]|2725.2||||2725.2||1962.14|463.28
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|WORKER'S COMP [2125]|TML WC [212537]|2725.2||||2725.2|1362.6|1962.14|463.28
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AARP [1000]|AARP [100000]|348.48||||348.48|174.24|250.91|59.24
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 MEDICARE REPLACEMENT [102002]|348.48||||348.48||250.91|59.24
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 [101529]|348.48||||348.48|240.8|250.91|59.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMBETTER [2930]|AMBETTER [293000]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|348.48||||348.48|163.79|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|250.91|250.91|59.24
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 HMO OF TEXAS [115504]|348.48||||348.48|209.09|250.91|59.24
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]|348.48||||348.48|243.94|250.91|59.24
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]|348.48||||348.48|212.57|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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 - GREAT WEST [126009]|348.48||||348.48|240.45|250.91|59.24
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 PPO [126025]|348.48||||348.48|209.09|250.91|59.24
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]|348.48||||348.48|174.24|250.91|59.24
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 [145000]|348.48||||348.48|240.45|250.91|59.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|348.48||||348.48|163.79|250.91|59.24
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 COMMERCIAL [214001]|348.48||||348.48|240.45|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|240.8|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|240.8|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48|240.45|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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|348.48||||348.48|69.7|250.91|59.24
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]|348.48||||348.48|240.45|250.91|59.24
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]|348.48||||348.48|59.24|250.91|59.24
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 UNITED HEALTHCARE [203502]|348.48||||348.48|174.24|250.91|59.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNICARE [2040]|UNICARE [204000]|348.48||||348.48|174.24|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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 MEDICA CHOICE [206030]|348.48||||348.48|174.24|250.91|59.24
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]|348.48||||348.48|240.45|250.91|59.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|TML WC [212537]|348.48||||348.48|174.24|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AARP [1000]|AARP [100000]|348.48||||348.48|174.24|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|348.48||||348.48||250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA [101529]|348.48||||348.48|240.8|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMBETTER [2930]|AMBETTER [293000]|348.48||||348.48||250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|348.48||||348.48|94.19|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|348.48||||348.48||250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|348.48||||348.48|163.79|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|348.48||||348.48|94.19|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|348.48||||348.48||250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|348.48||||348.48|250.91|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|348.48||||348.48|209.09|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|348.48||||348.48|243.94|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|348.48||||348.48|212.57|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|348.48||||348.48|94.19|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|348.48||||348.48||250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|348.48||||348.48|240.45|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA PPO [126025]|348.48||||348.48|209.09|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|348.48||||348.48|174.24|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA [145000]|348.48||||348.48|240.45|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|348.48||||348.48|163.79|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|348.48||||348.48|240.45|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|348.48||||348.48||250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|348.48||||348.48|240.8|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|348.48||||348.48|94.19|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|348.48||||348.48||250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|348.48||||348.48|240.8|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|348.48||||348.48|94.19|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHCS [1780]|PHCS MULTIPLAN [178000]|348.48||||348.48|240.45|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|348.48||||348.48|94.19|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|Self-pay|Self-pay|348.48||||348.48|69.7|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TML [1980]|TML [198000]|348.48||||348.48|240.45|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|348.48||||348.48|59.24|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|348.48||||348.48|174.24|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNICARE [2040]|UNICARE [204000]|348.48||||348.48|174.24|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|348.48||||348.48||250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|348.48||||348.48|174.24|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WEB TPA [2115]|WEB TPA [211500]|348.48||||348.48|240.45|250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|348.48||||348.48||250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|348.48||||348.48||250.91|59.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|TML WC [212537]|348.48||||348.48|174.24|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AARP [1000]|AARP [100000]|348.48||||348.48|174.24|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|348.48||||348.48||250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA [101529]|348.48||||348.48|240.8|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMBETTER [2930]|AMBETTER [293000]|348.48||||348.48||250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|348.48||||348.48|94.19|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|348.48||||348.48||250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|348.48||||348.48|163.79|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|348.48||||348.48|94.19|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|348.48||||348.48||250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|348.48||||348.48|250.91|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|348.48||||348.48|209.09|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|348.48||||348.48|243.94|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|348.48||||348.48|212.57|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|348.48||||348.48|94.19|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|348.48||||348.48||250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|348.48||||348.48|240.45|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA PPO [126025]|348.48||||348.48|209.09|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|348.48||||348.48|174.24|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA [145000]|348.48||||348.48|240.45|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|348.48||||348.48|163.79|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|348.48||||348.48|240.45|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|348.48||||348.48||250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|348.48||||348.48|240.8|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|348.48||||348.48|94.19|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|348.48||||348.48||250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|348.48||||348.48|240.8|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|348.48||||348.48|94.19|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHCS [1780]|PHCS MULTIPLAN [178000]|348.48||||348.48|240.45|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|348.48||||348.48|94.19|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|Self-pay|Self-pay|348.48||||348.48|69.7|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TML [1980]|TML [198000]|348.48||||348.48|240.45|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|348.48||||348.48|59.24|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|348.48||||348.48|174.24|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNICARE [2040]|UNICARE [204000]|348.48||||348.48|174.24|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|348.48||||348.48||250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|348.48||||348.48|174.24|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WEB TPA [2115]|WEB TPA [211500]|348.48||||348.48|240.45|250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|348.48||||348.48||250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|348.48||||348.48||250.91|59.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|TML WC [212537]|348.48||||348.48|174.24|250.91|59.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AARP [1000]|AARP [100000]|348.48||||348.48|174.24|250.91|59.24
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 MEDICARE REPLACEMENT [102002]|348.48||||348.48||250.91|59.24
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 [101529]|348.48||||348.48|240.8|250.91|59.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMBETTER [2930]|AMBETTER [293000]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|348.48||||348.48|163.79|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|250.91|250.91|59.24
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 HMO OF TEXAS [115504]|348.48||||348.48|209.09|250.91|59.24
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]|348.48||||348.48|243.94|250.91|59.24
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]|348.48||||348.48|212.57|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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 - GREAT WEST [126009]|348.48||||348.48|240.45|250.91|59.24
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 PPO [126025]|348.48||||348.48|209.09|250.91|59.24
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]|348.48||||348.48|174.24|250.91|59.24
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 [145000]|348.48||||348.48|240.45|250.91|59.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|348.48||||348.48|163.79|250.91|59.24
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 COMMERCIAL [214001]|348.48||||348.48|240.45|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|240.8|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|240.8|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48|240.45|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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|348.48||||348.48|69.7|250.91|59.24
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]|348.48||||348.48|240.45|250.91|59.24
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]|348.48||||348.48|59.24|250.91|59.24
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 UNITED HEALTHCARE [203502]|348.48||||348.48|174.24|250.91|59.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNICARE [2040]|UNICARE [204000]|348.48||||348.48|174.24|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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 MEDICA CHOICE [206030]|348.48||||348.48|174.24|250.91|59.24
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]|348.48||||348.48|240.45|250.91|59.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|TML WC [212537]|348.48||||348.48|174.24|250.91|59.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AARP [1000]|AARP [100000]|348.48||||348.48|174.24|250.91|59.24
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 MEDICARE REPLACEMENT [102002]|348.48||||348.48||250.91|59.24
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 [101529]|348.48||||348.48|240.8|250.91|59.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMBETTER [2930]|AMBETTER [293000]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|348.48||||348.48|163.79|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|250.91|250.91|59.24
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 HMO OF TEXAS [115504]|348.48||||348.48|209.09|250.91|59.24
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]|348.48||||348.48|243.94|250.91|59.24
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]|348.48||||348.48|212.57|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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 - GREAT WEST [126009]|348.48||||348.48|240.45|250.91|59.24
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 PPO [126025]|348.48||||348.48|209.09|250.91|59.24
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]|348.48||||348.48|174.24|250.91|59.24
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 [145000]|348.48||||348.48|240.45|250.91|59.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|348.48||||348.48|163.79|250.91|59.24
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 COMMERCIAL [214001]|348.48||||348.48|240.45|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|240.8|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|240.8|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48|240.45|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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|348.48||||348.48|69.7|250.91|59.24
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]|348.48||||348.48|240.45|250.91|59.24
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]|348.48||||348.48|59.24|250.91|59.24
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 UNITED HEALTHCARE [203502]|348.48||||348.48|174.24|250.91|59.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNICARE [2040]|UNICARE [204000]|348.48||||348.48|174.24|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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 MEDICA CHOICE [206030]|348.48||||348.48|174.24|250.91|59.24
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]|348.48||||348.48|240.45|250.91|59.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|TML WC [212537]|348.48||||348.48|174.24|250.91|59.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AARP [1000]|AARP [100000]|348.48||||348.48|174.24|250.91|59.24
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 MEDICARE REPLACEMENT [102002]|348.48||||348.48||250.91|59.24
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 [101529]|348.48||||348.48|240.8|250.91|59.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMBETTER [2930]|AMBETTER [293000]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|348.48||||348.48|163.79|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|250.91|250.91|59.24
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 HMO OF TEXAS [115504]|348.48||||348.48|209.09|250.91|59.24
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]|348.48||||348.48|243.94|250.91|59.24
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]|348.48||||348.48|212.57|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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 - GREAT WEST [126009]|348.48||||348.48|240.45|250.91|59.24
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 PPO [126025]|348.48||||348.48|209.09|250.91|59.24
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]|348.48||||348.48|174.24|250.91|59.24
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 [145000]|348.48||||348.48|240.45|250.91|59.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|348.48||||348.48|163.79|250.91|59.24
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 COMMERCIAL [214001]|348.48||||348.48|240.45|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|240.8|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48|240.8|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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]|348.48||||348.48|240.45|250.91|59.24
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]|348.48||||348.48|94.19|250.91|59.24
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|348.48||||348.48|69.7|250.91|59.24
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]|348.48||||348.48|240.45|250.91|59.24
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]|348.48||||348.48|59.24|250.91|59.24
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 UNITED HEALTHCARE [203502]|348.48||||348.48|174.24|250.91|59.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNICARE [2040]|UNICARE [204000]|348.48||||348.48|174.24|250.91|59.24
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]|348.48||||348.48||250.91|59.24
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 MEDICA CHOICE [206030]|348.48||||348.48|174.24|250.91|59.24
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]|348.48||||348.48|240.45|250.91|59.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|348.48||||348.48||250.91|59.24
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]|348.48||||348.48||250.91|59.24
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]|TML WC [212537]|348.48||||348.48|174.24|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AARP [1000]|AARP [100000]|348.48||||348.48|174.24|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|348.48||||348.48||250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA [101529]|348.48||||348.48|240.8|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMBETTER [2930]|AMBETTER [293000]|348.48||||348.48||250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|348.48||||348.48|94.19|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|348.48||||348.48||250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|348.48||||348.48|163.79|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|348.48||||348.48|94.19|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|348.48||||348.48||250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|348.48||||348.48|250.91|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|348.48||||348.48|209.09|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|348.48||||348.48|243.94|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|348.48||||348.48|212.57|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|348.48||||348.48|94.19|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|348.48||||348.48||250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|348.48||||348.48|240.45|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA PPO [126025]|348.48||||348.48|209.09|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|348.48||||348.48|174.24|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA [145000]|348.48||||348.48|240.45|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|348.48||||348.48|163.79|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|348.48||||348.48|240.45|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|348.48||||348.48||250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|348.48||||348.48|240.8|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|348.48||||348.48|94.19|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|348.48||||348.48||250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|348.48||||348.48|240.8|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|348.48||||348.48|94.19|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHCS [1780]|PHCS MULTIPLAN [178000]|348.48||||348.48|240.45|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|348.48||||348.48|94.19|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|Self-pay|Self-pay|348.48||||348.48|69.7|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TML [1980]|TML [198000]|348.48||||348.48|240.45|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|348.48||||348.48|59.24|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|348.48||||348.48|174.24|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNICARE [2040]|UNICARE [204000]|348.48||||348.48|174.24|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|348.48||||348.48||250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|348.48||||348.48|174.24|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WEB TPA [2115]|WEB TPA [211500]|348.48||||348.48|240.45|250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|348.48||||348.48||250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|348.48||||348.48||250.91|59.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|TML WC [212537]|348.48||||348.48|174.24|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AARP [1000]|AARP [100000]|348.48||||348.48|174.24|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|348.48||||348.48||250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA [101529]|348.48||||348.48|240.8|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMBETTER [2930]|AMBETTER [293000]|348.48||||348.48||250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|348.48||||348.48|94.19|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|348.48||||348.48||250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|348.48||||348.48|163.79|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|348.48||||348.48|94.19|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|348.48||||348.48||250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|348.48||||348.48|250.91|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|348.48||||348.48|209.09|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|348.48||||348.48|243.94|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|348.48||||348.48|212.57|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|348.48||||348.48|94.19|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|348.48||||348.48||250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|348.48||||348.48|240.45|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA PPO [126025]|348.48||||348.48|209.09|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|348.48||||348.48|174.24|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA [145000]|348.48||||348.48|240.45|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|348.48||||348.48|163.79|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|348.48||||348.48|240.45|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|348.48||||348.48||250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|348.48||||348.48|240.8|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|348.48||||348.48|94.19|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|348.48||||348.48||250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|348.48||||348.48|240.8|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|348.48||||348.48|94.19|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHCS [1780]|PHCS MULTIPLAN [178000]|348.48||||348.48|240.45|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|348.48||||348.48|94.19|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|Self-pay|Self-pay|348.48||||348.48|69.7|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TML [1980]|TML [198000]|348.48||||348.48|240.45|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|348.48||||348.48|59.24|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|348.48||||348.48|174.24|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNICARE [2040]|UNICARE [204000]|348.48||||348.48|174.24|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|348.48||||348.48||250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|348.48||||348.48|174.24|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WEB TPA [2115]|WEB TPA [211500]|348.48||||348.48|240.45|250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|348.48||||348.48||250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|348.48||||348.48||250.91|59.24
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|TML WC [212537]|348.48||||348.48|174.24|250.91|59.24
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AARP [1000]|AARP [100000]|136.11||||136.11|68.06|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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 MEDICARE REPLACEMENT [102002]|136.11||||136.11||98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA [101529]|136.11||||136.11|94.05|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMBETTER [2930]|AMBETTER [293000]|136.11||||136.11||98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|36.79|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11||98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|136.11||||136.11|63.97|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|36.79|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11||98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|98|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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 HMO OF TEXAS [115504]|136.11||||136.11|81.67|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|95.28|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|83.03|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|36.79|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11||98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|136.11||||136.11|93.92|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA PPO [126025]|136.11||||136.11|81.67|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|68.06|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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 [145000]|136.11||||136.11|93.92|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|136.11||||136.11|63.97|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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 COMMERCIAL [214001]|136.11||||136.11|93.92|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11||98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|94.05|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|36.79|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11||98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|94.05|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|36.79|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|93.92|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|36.79|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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|136.11||||136.11|27.22|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|93.92|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|23.14|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|136.11||||136.11|68.06|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNICARE [2040]|UNICARE [204000]|136.11||||136.11|68.06|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11||98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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 MEDICA CHOICE [206030]|136.11||||136.11|68.06|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11|93.92|98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|136.11||||136.11||98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|136.11||||136.11||98|23.14
10005|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L16 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]|TML WC [212537]|136.11||||136.11|68.06|98|23.14
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|AARP [1000]|AARP [100000]|8322.3||||8322.3|4161.15|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8322.3||||8322.3||5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|AETNA [1015]|AETNA [101529]|8322.3||||8322.3|5750.71|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|AMBETTER [2930]|AMBETTER [293000]|8322.3||||8322.3||5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|8322.3||||8322.3|2249.52|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8322.3||||8322.3||5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|8322.3||||8322.3|3911.48|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|8322.3||||8322.3|2249.52|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8322.3||||8322.3||5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|8322.3||||8322.3|5992.06|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|8322.3||||8322.3|4993.38|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|8322.3||||8322.3|5825.61|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|8322.3||||8322.3|5076.6|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|8322.3||||8322.3|2249.52|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8322.3||||8322.3||5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|8322.3||||8322.3|5742.39|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|CIGNA [1260]|CIGNA PPO [126025]|8322.3||||8322.3|4993.38|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|8322.3||||8322.3|4161.15|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|GROUP PENSION ADMIN [1450]|GPA [145000]|8322.3||||8322.3|5742.39|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|8322.3||||8322.3|3911.48|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8322.3||||8322.3|5742.39|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8322.3||||8322.3||5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|8322.3||||8322.3|5750.71|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|8322.3||||8322.3|2249.52|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8322.3||||8322.3||5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|8322.3||||8322.3|5750.71|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8322.3||||8322.3|2249.52|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|PHCS [1780]|PHCS MULTIPLAN [178000]|8322.3||||8322.3|5742.39|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|8322.3||||8322.3|2249.52|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|Self-pay|Self-pay|8322.3||||8322.3|1664.46|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|TML [1980]|TML [198000]|8322.3||||8322.3|5742.39|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|8322.3||||8322.3|1414.79|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|8322.3||||8322.3|4161.15|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|UNICARE [2040]|UNICARE [204000]|8322.3||||8322.3|4161.15|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8322.3||||8322.3||5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|8322.3||||8322.3|4161.15|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|WEB TPA [2115]|WEB TPA [211500]|8322.3||||8322.3|5742.39|5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|8322.3||||8322.3||5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|8322.3||||8322.3||5992.06|1414.79
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|WORKER'S COMP [2125]|TML WC [212537]|8322.3||||8322.3|4161.15|5992.06|1414.79
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AARP [1000]|AARP [100000]|1644||||1644|822|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1644||||1644||1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA [101529]|1644||||1644|1136|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMBETTER [2930]|AMBETTER [293000]|1644||||1644||1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1644||||1644|444.37|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1644||||1644||1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|1644||||1644|772.68|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1644||||1644|444.37|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1644||||1644||1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1644||||1644|1183.68|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|1644||||1644|986.4|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1644||||1644|1150.8|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1644||||1644|1002.84|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|1644||||1644|444.37|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1644||||1644||1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1644||||1644|1134.36|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA [1260]|CIGNA PPO [126025]|1644||||1644|986.4|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1644||||1644|822|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP PENSION ADMIN [1450]|GPA [145000]|1644||||1644|1134.36|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|1644||||1644|772.68|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1644||||1644|1134.36|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1644||||1644||1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1644||||1644|1136|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1644||||1644|444.37|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1644||||1644||1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1644||||1644|1136|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1644||||1644|444.37|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|PHCS MULTIPLAN [178000]|1644||||1644|1134.36|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1644||||1644|444.37|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|Self-pay|Self-pay|1644||||1644|328.8|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TML [1980]|TML [198000]|1644||||1644|1134.36|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1644||||1644|279.48|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1644||||1644|822|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNICARE [2040]|UNICARE [204000]|1644||||1644|822|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1644||||1644||1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1644||||1644|822|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WEB TPA [2115]|WEB TPA [211500]|1644||||1644|1134.36|1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1644||||1644||1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|1644||||1644||1183.68|279.48
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|TML WC [212537]|1644||||1644|822|1183.68|279.48
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|AARP [1000]|AARP [100000]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|AETNA [1015]|AETNA [101529]|2.61||||2.61|1.8|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|AMBETTER [2930]|AMBETTER [293000]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2.61||||2.61|0.71|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|2.61||||2.61|1.31|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2.61||||2.61|0.71|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2.61||||2.61|1.88|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|2.61||||2.61|1.57|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2.61||||2.61|1.83|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2.61||||2.61|1.72|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2.61||||2.61|0.71|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2.61||||2.61|1.8|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|CIGNA [1260]|CIGNA PPO [126025]|2.61||||2.61|1.57|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|GROUP PENSION ADMIN [1450]|GPA [145000]|2.61||||2.61|1.8|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|2.61||||2.61|1.31|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2.61||||2.61|1.8|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2.61||||2.61|1.8|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2.61||||2.61|0.71|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2.61||||2.61|1.8|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2.61||||2.61|0.71|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2.61||||2.61|1.8|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2.61||||2.61|0.71|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|Self-pay|Self-pay|2.61||||2.61|0.52|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|TML [1980]|TML [198000]|2.61||||2.61|1.8|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2.61||||2.61|0.44|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|UNICARE [2040]|UNICARE [204000]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|WEB TPA [2115]|WEB TPA [211500]|2.61||||2.61|1.8|1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2.61||||2.61||1.88|0.44
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|1|WORKER'S COMP [2125]|TML WC [212537]|2.61||||2.61||1.88|0.44
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|AARP [1000]|AARP [100000]|2.61||||2.61||1.88|0.44
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 MEDICARE REPLACEMENT [102002]|2.61||||2.61||1.88|0.44
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 [101529]|2.61||||2.61|1.8|1.88|0.44
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|AMBETTER [2930]|AMBETTER [293000]|2.61||||2.61||1.88|0.44
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]|2.61||||2.61|0.71|1.88|0.44
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]|2.61||||2.61||1.88|0.44
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|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|2.61||||2.61|1.31|1.88|0.44
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]|2.61||||2.61|0.71|1.88|0.44
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]|2.61||||2.61||1.88|0.44
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]|2.61||||2.61|1.88|1.88|0.44
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 HMO OF TEXAS [115504]|2.61||||2.61|1.57|1.88|0.44
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]|2.61||||2.61|1.83|1.88|0.44
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]|2.61||||2.61|1.72|1.88|0.44
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]|2.61||||2.61|0.71|1.88|0.44
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]|2.61||||2.61||1.88|0.44
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 - GREAT WEST [126009]|2.61||||2.61|1.8|1.88|0.44
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 PPO [126025]|2.61||||2.61|1.57|1.88|0.44
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]|2.61||||2.61||1.88|0.44
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 [145000]|2.61||||2.61|1.8|1.88|0.44
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 [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|2.61||||2.61|1.31|1.88|0.44
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 COMMERCIAL [214001]|2.61||||2.61|1.8|1.88|0.44
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]|2.61||||2.61||1.88|0.44
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]|2.61||||2.61|1.8|1.88|0.44
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]|2.61||||2.61|0.71|1.88|0.44
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]|2.61||||2.61||1.88|0.44
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]|2.61||||2.61|1.8|1.88|0.44
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]|2.61||||2.61|0.71|1.88|0.44
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]|2.61||||2.61|1.8|1.88|0.44
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]|2.61||||2.61|0.71|1.88|0.44
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|2.61||||2.61|0.52|1.88|0.44
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]|2.61||||2.61|1.8|1.88|0.44
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]|2.61||||2.61|0.44|1.88|0.44
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 UNITED HEALTHCARE [203502]|2.61||||2.61||1.88|0.44
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|UNICARE [2040]|UNICARE [204000]|2.61||||2.61||1.88|0.44
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]|2.61||||2.61||1.88|0.44
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 MEDICA CHOICE [206030]|2.61||||2.61||1.88|0.44
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]|2.61||||2.61|1.8|1.88|0.44
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 MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|2.61||||2.61||1.88|0.44
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]|2.61||||2.61||1.88|0.44
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]|TML WC [212537]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|AARP [1000]|AARP [100000]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|AETNA [1015]|AETNA [101529]|2.61||||2.61|1.8|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|AMBETTER [2930]|AMBETTER [293000]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2.61||||2.61|0.71|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|2.61||||2.61|1.31|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2.61||||2.61|0.71|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2.61||||2.61|1.88|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|2.61||||2.61|1.57|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2.61||||2.61|1.83|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2.61||||2.61|1.72|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2.61||||2.61|0.71|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2.61||||2.61|1.8|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|CIGNA [1260]|CIGNA PPO [126025]|2.61||||2.61|1.57|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|GROUP PENSION ADMIN [1450]|GPA [145000]|2.61||||2.61|1.8|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|2.61||||2.61|1.31|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2.61||||2.61|1.8|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2.61||||2.61|1.8|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2.61||||2.61|0.71|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2.61||||2.61|1.8|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2.61||||2.61|0.71|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2.61||||2.61|1.8|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2.61||||2.61|0.71|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|Self-pay|Self-pay|2.61||||2.61|0.52|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|TML [1980]|TML [198000]|2.61||||2.61|1.8|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2.61||||2.61|0.44|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|UNICARE [2040]|UNICARE [204000]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|WEB TPA [2115]|WEB TPA [211500]|2.61||||2.61|1.8|1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2.61||||2.61||1.88|0.44
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|1|WORKER'S COMP [2125]|TML WC [212537]|2.61||||2.61||1.88|0.44
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|AARP [1000]|AARP [100000]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|AETNA [1015]|AETNA [101529]|7.89||||7.89|5.45|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|AMBETTER [2930]|AMBETTER [293000]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.89||||7.89|2.13|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|7.89||||7.89|3.95|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|7.89||||7.89|2.13|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|7.89||||7.89|5.68|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|7.89||||7.89|4.73|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|7.89||||7.89|5.52|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|7.89||||7.89|5.21|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|7.89||||7.89|2.13|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|7.89||||7.89|5.44|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|CIGNA [1260]|CIGNA PPO [126025]|7.89||||7.89|4.73|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|7.89||||7.89|5.44|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|7.89||||7.89|3.95|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7.89||||7.89|5.44|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7.89||||7.89|5.45|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|7.89||||7.89|2.13|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|7.89||||7.89|5.45|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7.89||||7.89|2.13|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|7.89||||7.89|5.44|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|7.89||||7.89|2.13|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|Self-pay|Self-pay|7.89||||7.89|1.58|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|TML [1980]|TML [198000]|7.89||||7.89|5.44|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|7.89||||7.89|1.34|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|UNICARE [2040]|UNICARE [204000]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|WEB TPA [2115]|WEB TPA [211500]|7.89||||7.89|5.44|5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|7.89||||7.89||5.68|1.34
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|WORKER'S COMP [2125]|TML WC [212537]|7.89||||7.89||5.68|1.34
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|AARP [1000]|AARP [100000]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|AETNA [1015]|AETNA [101529]|7.47||||7.47|5.16|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|AMBETTER [2930]|AMBETTER [293000]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.47||||7.47|2.02|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|7.47||||7.47|3.74|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|7.47||||7.47|2.02|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|7.47||||7.47|5.38|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|7.47||||7.47|4.48|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|7.47||||7.47|5.23|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|7.47||||7.47|4.93|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|7.47||||7.47|2.02|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|7.47||||7.47|5.15|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|CIGNA [1260]|CIGNA PPO [126025]|7.47||||7.47|4.48|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|GROUP PENSION ADMIN [1450]|GPA [145000]|7.47||||7.47|5.15|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|7.47||||7.47|3.74|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7.47||||7.47|5.15|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7.47||||7.47|5.16|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|7.47||||7.47|2.02|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|7.47||||7.47|5.16|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7.47||||7.47|2.02|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|PHCS [1780]|PHCS MULTIPLAN [178000]|7.47||||7.47|5.15|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|7.47||||7.47|2.02|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|Self-pay|Self-pay|7.47||||7.47|1.49|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|TML [1980]|TML [198000]|7.47||||7.47|5.15|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|7.47||||7.47|1.27|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|UNICARE [2040]|UNICARE [204000]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|WEB TPA [2115]|WEB TPA [211500]|7.47||||7.47|5.15|5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|7.47||||7.47||5.38|1.27
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1|WORKER'S COMP [2125]|TML WC [212537]|7.47||||7.47||5.38|1.27
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|AARP [1000]|AARP [100000]|750||||750||540|127.5
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 MEDICARE REPLACEMENT [102002]|750||||750||540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|AETNA [1015]|AETNA [101529]|750||||750|518.25|540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|AMBETTER [2930]|AMBETTER [293000]|750||||750||540|127.5
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]|750||||750|202.73|540|127.5
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]|750||||750||540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|750||||750|375|540|127.5
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]|750||||750|202.73|540|127.5
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]|750||||750||540|127.5
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]|750||||750|540|540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|750||||750|450|540|127.5
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]|750||||750|525|540|127.5
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]|750||||750|495|540|127.5
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]|750||||750|202.73|540|127.5
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]|750||||750||540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|750||||750|517.5|540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|CIGNA [1260]|CIGNA PPO [126025]|750||||750|450|540|127.5
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]|750||||750||540|127.5
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 [145000]|750||||750|517.5|540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|750||||750|375|540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|750||||750|517.5|540|127.5
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]|750||||750||540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|750||||750|518.25|540|127.5
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]|750||||750|202.73|540|127.5
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]|750||||750||540|127.5
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]|750||||750|518.25|540|127.5
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]|750||||750|202.73|540|127.5
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]|750||||750|517.5|540|127.5
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]|750||||750|202.73|540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|Self-pay|Self-pay|750||||750|150|540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|TML [1980]|TML [198000]|750||||750|517.5|540|127.5
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]|750||||750|127.5|540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|750||||750||540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UNICARE [2040]|UNICARE [204000]|750||||750||540|127.5
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]|750||||750||540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|750||||750||540|127.5
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]|750||||750|517.5|540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|750||||750||540|127.5
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]|750||||750||540|127.5
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1|WORKER'S COMP [2125]|TML WC [212537]|750||||750||540|127.5
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|AARP [1000]|AARP [100000]|64.5||||64.5|32.25|46.44|10.97
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 MEDICARE REPLACEMENT [102002]|64.5||||64.5||46.44|10.97
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|AETNA [1015]|AETNA [101529]|64.5||||64.5|44.57|46.44|10.97
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|AMBETTER [2930]|AMBETTER [293000]|64.5||||64.5||46.44|10.97
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]|64.5||||64.5|17.43|46.44|10.97
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]|64.5||||64.5||46.44|10.97
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|64.5||||64.5|32.25|46.44|10.97
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]|64.5||||64.5|17.43|46.44|10.97
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]|64.5||||64.5||46.44|10.97
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]|64.5||||64.5|46.44|46.44|10.97
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 HMO OF TEXAS [115504]|64.5||||64.5|38.7|46.44|10.97
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]|64.5||||64.5|45.15|46.44|10.97
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]|64.5||||64.5|42.57|46.44|10.97
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]|64.5||||64.5|17.43|46.44|10.97
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]|64.5||||64.5||46.44|10.97
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|64.5||||64.5|44.51|46.44|10.97
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|CIGNA [1260]|CIGNA PPO [126025]|64.5||||64.5|38.7|46.44|10.97
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]|64.5||||64.5|32.25|46.44|10.97
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 [145000]|64.5||||64.5|44.51|46.44|10.97
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|64.5||||64.5|32.25|46.44|10.97
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 COMMERCIAL [214001]|64.5||||64.5|44.51|46.44|10.97
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]|64.5||||64.5||46.44|10.97
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]|64.5||||64.5|44.57|46.44|10.97
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]|64.5||||64.5|17.43|46.44|10.97
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]|64.5||||64.5||46.44|10.97
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]|64.5||||64.5|44.57|46.44|10.97
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]|64.5||||64.5|17.43|46.44|10.97
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]|64.5||||64.5|44.51|46.44|10.97
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]|64.5||||64.5|17.43|46.44|10.97
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|64.5||||64.5|12.9|46.44|10.97
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]|64.5||||64.5|44.51|46.44|10.97
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]|64.5||||64.5|10.97|46.44|10.97
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|64.5||||64.5|32.25|46.44|10.97
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|UNICARE [2040]|UNICARE [204000]|64.5||||64.5|32.25|46.44|10.97
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]|64.5||||64.5||46.44|10.97
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 MEDICA CHOICE [206030]|64.5||||64.5|32.25|46.44|10.97
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]|64.5||||64.5|44.51|46.44|10.97
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|64.5||||64.5||46.44|10.97
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]|64.5||||64.5||46.44|10.97
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]|TML WC [212537]|64.5||||64.5|32.25|46.44|10.97
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AARP [1000]|AARP [100000]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA [101529]|1.87||||1.87|1.29|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMBETTER [2930]|AMBETTER [293000]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.87||||1.87|0.51|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|1.87||||1.87|0.94|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.87||||1.87|0.51|98|0.32
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]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.87||||1.87|1.35|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|1.87||||1.87|1.12|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.87||||1.87|1.31|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.87||||1.87|1.23|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|1.87||||1.87|0.51|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1.87||||1.87|1.29|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA [1260]|CIGNA PPO [126025]|1.87||||1.87|1.12|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA [145000]|1.87||||1.87|1.29|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|1.87||||1.87|0.94|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1.87||||1.87|1.29|98|0.32
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]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.87||||1.87|1.29|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.87||||1.87|0.51|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1.87||||1.87|1.29|98|0.32
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]|1.87||||1.87|0.51|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PHCS [1780]|PHCS MULTIPLAN [178000]|1.87||||1.87|1.29|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.87||||1.87|0.51|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|Self-pay|Self-pay|1.87||||1.87|0.37|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|TML [1980]|TML [198000]|1.87||||1.87|1.29|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1.87||||1.87|0.32|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNICARE [2040]|UNICARE [204000]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WEB TPA [2115]|WEB TPA [211500]|1.87||||1.87|1.29|98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|1.87||||1.87||98|0.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|TML WC [212537]|1.87||||1.87||98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AARP [1000]|AARP [100000]|136.11||||136.11|68.06|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|136.11||||136.11||98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA [101529]|136.11||||136.11|94.05|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMBETTER [2930]|AMBETTER [293000]|136.11||||136.11||98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|136.11||||136.11|36.79|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|136.11||||136.11||98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|136.11||||136.11|63.97|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|136.11||||136.11|36.79|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11||98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11|98|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|136.11||||136.11|81.67|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11|95.28|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11|83.03|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11|36.79|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11||98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|136.11||||136.11|93.92|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA PPO [126025]|136.11||||136.11|81.67|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11|68.06|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GROUP PENSION ADMIN [1450]|GPA [145000]|136.11||||136.11|93.92|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|136.11||||136.11|63.97|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|136.11||||136.11|93.92|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11||98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|136.11||||136.11|94.05|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11|36.79|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11||98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|136.11||||136.11|94.05|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11|36.79|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHCS [1780]|PHCS MULTIPLAN [178000]|136.11||||136.11|93.92|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11|36.79|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|Self-pay|Self-pay|136.11||||136.11|27.22|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TML [1980]|TML [198000]|136.11||||136.11|93.92|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11|23.14|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|136.11||||136.11|68.06|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNICARE [2040]|UNICARE [204000]|136.11||||136.11|68.06|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11||98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|136.11||||136.11|68.06|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WEB TPA [2115]|WEB TPA [211500]|136.11||||136.11|93.92|98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|136.11||||136.11||98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 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]|136.11||||136.11||98|0.32
10011|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WORKER'S COMP [2125]|TML WC [212537]|136.11||||136.11|68.06|98|0.32
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AARP [1000]|AARP [100000]|1369.8||||1369.8|684.9|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1369.8||||1369.8||986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA [101529]|1369.8||||1369.8|946.53|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AMBETTER [2930]|AMBETTER [293000]|1369.8||||1369.8||986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1369.8||||1369.8|370.26|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1369.8||||1369.8||986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|1369.8||||1369.8|643.81|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1369.8||||1369.8|370.26|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1369.8||||1369.8||986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1369.8||||1369.8|986.26|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|1369.8||||1369.8|821.88|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1369.8||||1369.8|958.86|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1369.8||||1369.8|835.58|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|1369.8||||1369.8|370.26|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1369.8||||1369.8||986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1369.8||||1369.8|945.16|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|CIGNA [1260]|CIGNA PPO [126025]|1369.8||||1369.8|821.88|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1369.8||||1369.8|684.9|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|1369.8||||1369.8|945.16|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|1369.8||||1369.8|643.81|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1369.8||||1369.8|945.16|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1369.8||||1369.8||986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1369.8||||1369.8|946.53|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1369.8||||1369.8|370.26|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1369.8||||1369.8||986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1369.8||||1369.8|946.53|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1369.8||||1369.8|370.26|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|1369.8||||1369.8|945.16|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1369.8||||1369.8|370.26|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|Self-pay|Self-pay|1369.8||||1369.8|273.96|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|TML [1980]|TML [198000]|1369.8||||1369.8|945.16|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1369.8||||1369.8|232.87|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1369.8||||1369.8|684.9|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UNICARE [2040]|UNICARE [204000]|1369.8||||1369.8|684.9|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1369.8||||1369.8||986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1369.8||||1369.8|684.9|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|WEB TPA [2115]|WEB TPA [211500]|1369.8||||1369.8|945.16|986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1369.8||||1369.8||986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|1369.8||||1369.8||986.26|232.87
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|WORKER'S COMP [2125]|TML WC [212537]|1369.8||||1369.8|684.9|986.26|232.87
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|AARP [1000]|AARP [100000]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|AETNA [101529]|11.82||||11.82|8.17|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|AMBETTER [2930]|AMBETTER [293000]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|11.82||||11.82|3.19|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|11.82||||11.82|5.91|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|11.82||||11.82|3.19|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|11.82||||11.82|8.51|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|11.82||||11.82|7.09|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|11.82||||11.82|8.27|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|11.82||||11.82|7.8|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|11.82||||11.82|3.19|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|11.82||||11.82|8.16|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|CIGNA [1260]|CIGNA PPO [126025]|11.82||||11.82|7.09|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|11.82||||11.82|8.16|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|11.82||||11.82|5.91|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.82||||11.82|8.16|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|11.82||||11.82|8.17|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|11.82||||11.82|3.19|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|11.82||||11.82|8.17|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.82||||11.82|3.19|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|11.82||||11.82|8.16|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|11.82||||11.82|3.19|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|Self-pay|Self-pay|11.82||||11.82|2.36|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|TML [1980]|TML [198000]|11.82||||11.82|8.16|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|11.82||||11.82|2.01|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|UNICARE [2040]|UNICARE [204000]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|WEB TPA [2115]|WEB TPA [211500]|11.82||||11.82|8.16|8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|11.82||||11.82||8.51|2.01
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|WORKER'S COMP [2125]|TML WC [212537]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AARP [1000]|AARP [100000]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AETNA [1015]|AETNA [101529]|11.82||||11.82|8.17|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AMBETTER [2930]|AMBETTER [293000]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|11.82||||11.82|3.19|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|11.82||||11.82|5.91|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|11.82||||11.82|3.19|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|11.82||||11.82|8.51|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|11.82||||11.82|7.09|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|11.82||||11.82|8.27|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|11.82||||11.82|7.8|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|11.82||||11.82|3.19|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|11.82||||11.82|8.16|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|CIGNA [1260]|CIGNA PPO [126025]|11.82||||11.82|7.09|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|GROUP PENSION ADMIN [1450]|GPA [145000]|11.82||||11.82|8.16|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|11.82||||11.82|5.91|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.82||||11.82|8.16|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|11.82||||11.82|8.17|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|11.82||||11.82|3.19|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|11.82||||11.82|8.17|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.82||||11.82|3.19|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|PHCS [1780]|PHCS MULTIPLAN [178000]|11.82||||11.82|8.16|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|11.82||||11.82|3.19|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|Self-pay|Self-pay|11.82||||11.82|2.36|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|TML [1980]|TML [198000]|11.82||||11.82|8.16|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|11.82||||11.82|2.01|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UNICARE [2040]|UNICARE [204000]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|WEB TPA [2115]|WEB TPA [211500]|11.82||||11.82|8.16|8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|11.82||||11.82||8.51|2.01
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|WORKER'S COMP [2125]|TML WC [212537]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|AARP [1000]|AARP [100000]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|AETNA [101529]|11.82||||11.82|8.17|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|AMBETTER [2930]|AMBETTER [293000]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|11.82||||11.82|3.19|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|11.82||||11.82|5.91|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|11.82||||11.82|3.19|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|11.82||||11.82|8.51|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|11.82||||11.82|7.09|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|11.82||||11.82|8.27|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|11.82||||11.82|7.8|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|11.82||||11.82|3.19|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|11.82||||11.82|8.16|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|CIGNA [1260]|CIGNA PPO [126025]|11.82||||11.82|7.09|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|11.82||||11.82|8.16|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|11.82||||11.82|5.91|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.82||||11.82|8.16|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|11.82||||11.82|8.17|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|11.82||||11.82|3.19|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|11.82||||11.82|8.17|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.82||||11.82|3.19|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|11.82||||11.82|8.16|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|11.82||||11.82|3.19|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|Self-pay|Self-pay|11.82||||11.82|2.36|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|TML [1980]|TML [198000]|11.82||||11.82|8.16|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|11.82||||11.82|2.01|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|UNICARE [2040]|UNICARE [204000]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|WEB TPA [2115]|WEB TPA [211500]|11.82||||11.82|8.16|8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|11.82||||11.82||8.51|2.01
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1|WORKER'S COMP [2125]|TML WC [212537]|11.82||||11.82||8.51|2.01
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AARP [1000]|AARP [100000]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AETNA [1015]|AETNA [101529]|280.5||||280.5|193.83|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AMBETTER [2930]|AMBETTER [293000]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|280.5||||280.5|75.82|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|280.5||||280.5|140.25|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|280.5||||280.5|75.82|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|280.5||||280.5|201.96|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|280.5||||280.5|0|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|280.5||||280.5|196.35|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|280.5||||280.5|0|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|280.5||||280.5|75.82|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|280.5||||280.5|193.55|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CIGNA [1260]|CIGNA PPO [126025]|280.5||||280.5|168.3|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|GROUP PENSION ADMIN [1450]|GPA [145000]|280.5||||280.5|193.55|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|280.5||||280.5|140.25|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|280.5||||280.5|193.55|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|280.5||||280.5|193.83|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|280.5||||280.5|75.82|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|280.5||||280.5|193.83|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|280.5||||280.5|75.82|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|PHCS [1780]|PHCS MULTIPLAN [178000]|280.5||||280.5|193.55|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|280.5||||280.5|75.82|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|Self-pay|Self-pay|280.5||||280.5|56.1|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|TML [1980]|TML [198000]|280.5||||280.5|193.55|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|280.5||||280.5|47.69|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UMR [2035]|UMR UNITED HEALTHCARE [203502]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UNICARE [2040]|UNICARE [204000]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|WEB TPA [2115]|WEB TPA [211500]|280.5||||280.5|193.55|201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|280.5||||280.5||201.96|23.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|WORKER'S COMP [2125]|TML WC [212537]|280.5||||280.5||201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AARP [1000]|AARP [100000]|136.11||||136.11|68.06|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|136.11||||136.11||201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA [101529]|136.11||||136.11|94.05|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMBETTER [2930]|AMBETTER [293000]|136.11||||136.11||201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|136.11||||136.11|36.79|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|136.11||||136.11||201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|136.11||||136.11|63.97|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|136.11||||136.11|36.79|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11||201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11|98|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|136.11||||136.11|81.67|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11|95.28|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11|83.03|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11|36.79|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11||201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|136.11||||136.11|93.92|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA [1260]|CIGNA PPO [126025]|136.11||||136.11|81.67|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11|68.06|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GROUP PENSION ADMIN [1450]|GPA [145000]|136.11||||136.11|93.92|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|136.11||||136.11|63.97|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|136.11||||136.11|93.92|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11||201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|136.11||||136.11|94.05|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11|36.79|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11||201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|136.11||||136.11|94.05|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11|36.79|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHCS [1780]|PHCS MULTIPLAN [178000]|136.11||||136.11|93.92|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11|36.79|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|Self-pay|Self-pay|136.11||||136.11|27.22|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TML [1980]|TML [198000]|136.11||||136.11|93.92|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11|23.14|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|136.11||||136.11|68.06|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNICARE [2040]|UNICARE [204000]|136.11||||136.11|68.06|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11||201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|136.11||||136.11|68.06|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WEB TPA [2115]|WEB TPA [211500]|136.11||||136.11|93.92|201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|136.11||||136.11||201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 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]|136.11||||136.11||201.96|23.14
10014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WORKER'S COMP [2125]|TML WC [212537]|136.11||||136.11|68.06|201.96|23.14
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AARP [1000]|AARP [100000]|137.25||||137.25|68.63|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137.25||||137.25||98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|137.25||||137.25|94.84|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|137.25||||137.25||98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|137.25||||137.25|37.1|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137.25||||137.25||98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|137.25||||137.25|64.51|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|137.25||||137.25|37.1|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137.25||||137.25||98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|137.25||||137.25|98.82|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|137.25||||137.25|82.35|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|137.25||||137.25|96.08|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|137.25||||137.25|83.72|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|137.25||||137.25|37.1|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137.25||||137.25||98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|137.25||||137.25|94.7|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|137.25||||137.25|82.35|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|137.25||||137.25|68.63|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|137.25||||137.25|94.7|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|137.25||||137.25|64.51|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137.25||||137.25|94.7|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137.25||||137.25||98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|137.25||||137.25|94.84|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|137.25||||137.25|37.1|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137.25||||137.25||98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|137.25||||137.25|94.84|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137.25||||137.25|37.1|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|137.25||||137.25|94.7|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|137.25||||137.25|37.1|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|Self-pay|Self-pay|137.25||||137.25|27.45|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TML [1980]|TML [198000]|137.25||||137.25|94.7|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|137.25||||137.25|23.33|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|137.25||||137.25|68.63|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|137.25||||137.25|68.63|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137.25||||137.25||98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|137.25||||137.25|68.63|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|137.25||||137.25|94.7|98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|137.25||||137.25||98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|137.25||||137.25||98.82|23.33
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|137.25||||137.25|68.63|98.82|23.33
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AARP [1000]|AARP [100000]|137.25||||137.25|68.63|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137.25||||137.25||98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|137.25||||137.25|94.84|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|137.25||||137.25||98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|137.25||||137.25|37.1|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137.25||||137.25||98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|137.25||||137.25|64.51|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|137.25||||137.25|37.1|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137.25||||137.25||98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|137.25||||137.25|98.82|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|137.25||||137.25|82.35|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|137.25||||137.25|96.08|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|137.25||||137.25|83.72|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|137.25||||137.25|37.1|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137.25||||137.25||98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|137.25||||137.25|94.7|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|137.25||||137.25|82.35|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|137.25||||137.25|68.63|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|137.25||||137.25|94.7|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|137.25||||137.25|64.51|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137.25||||137.25|94.7|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137.25||||137.25||98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|137.25||||137.25|94.84|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|137.25||||137.25|37.1|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137.25||||137.25||98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|137.25||||137.25|94.84|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137.25||||137.25|37.1|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|137.25||||137.25|94.7|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|137.25||||137.25|37.1|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|Self-pay|Self-pay|137.25||||137.25|27.45|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TML [1980]|TML [198000]|137.25||||137.25|94.7|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|137.25||||137.25|23.33|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|137.25||||137.25|68.63|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|137.25||||137.25|68.63|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137.25||||137.25||98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|137.25||||137.25|68.63|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|137.25||||137.25|94.7|98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|137.25||||137.25||98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|137.25||||137.25||98.82|23.33
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|137.25||||137.25|68.63|98.82|23.33
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AARP [1000]|AARP [100000]|137.25||||137.25|68.63|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137.25||||137.25||98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|137.25||||137.25|94.84|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|137.25||||137.25||98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|137.25||||137.25|37.1|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137.25||||137.25||98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|137.25||||137.25|64.51|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|137.25||||137.25|37.1|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137.25||||137.25||98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|137.25||||137.25|98.82|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|137.25||||137.25|82.35|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|137.25||||137.25|96.08|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|137.25||||137.25|83.72|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|137.25||||137.25|37.1|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137.25||||137.25||98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|137.25||||137.25|94.7|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|137.25||||137.25|82.35|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|137.25||||137.25|68.63|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|137.25||||137.25|94.7|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|137.25||||137.25|64.51|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137.25||||137.25|94.7|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137.25||||137.25||98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|137.25||||137.25|94.84|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|137.25||||137.25|37.1|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137.25||||137.25||98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|137.25||||137.25|94.84|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137.25||||137.25|37.1|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|137.25||||137.25|94.7|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|137.25||||137.25|37.1|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|Self-pay|Self-pay|137.25||||137.25|27.45|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TML [1980]|TML [198000]|137.25||||137.25|94.7|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|137.25||||137.25|23.33|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|137.25||||137.25|68.63|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|137.25||||137.25|68.63|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137.25||||137.25||98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|137.25||||137.25|68.63|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|137.25||||137.25|94.7|98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|137.25||||137.25||98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|137.25||||137.25||98.82|23.33
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|137.25||||137.25|68.63|98.82|23.33
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AARP [1000]|AARP [100000]|137.25||||137.25|68.63|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137.25||||137.25||98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|137.25||||137.25|94.84|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|137.25||||137.25||98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|137.25||||137.25|37.1|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137.25||||137.25||98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|137.25||||137.25|64.51|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|137.25||||137.25|37.1|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137.25||||137.25||98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|137.25||||137.25|98.82|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|137.25||||137.25|82.35|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|137.25||||137.25|96.08|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|137.25||||137.25|83.72|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|137.25||||137.25|37.1|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137.25||||137.25||98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|137.25||||137.25|94.7|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|137.25||||137.25|82.35|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|137.25||||137.25|68.63|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|137.25||||137.25|94.7|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|137.25||||137.25|64.51|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137.25||||137.25|94.7|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137.25||||137.25||98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|137.25||||137.25|94.84|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|137.25||||137.25|37.1|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137.25||||137.25||98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|137.25||||137.25|94.84|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137.25||||137.25|37.1|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|137.25||||137.25|94.7|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|137.25||||137.25|37.1|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|Self-pay|Self-pay|137.25||||137.25|27.45|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TML [1980]|TML [198000]|137.25||||137.25|94.7|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|137.25||||137.25|23.33|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|137.25||||137.25|68.63|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|137.25||||137.25|68.63|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137.25||||137.25||98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|137.25||||137.25|68.63|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|137.25||||137.25|94.7|98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|137.25||||137.25||98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|137.25||||137.25||98.82|23.33
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|137.25||||137.25|68.63|98.82|23.33
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AARP [1000]|AARP [100000]|137.25||||137.25|68.63|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137.25||||137.25||98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|137.25||||137.25|94.84|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|137.25||||137.25||98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|137.25||||137.25|37.1|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137.25||||137.25||98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|137.25||||137.25|64.51|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|137.25||||137.25|37.1|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137.25||||137.25||98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|137.25||||137.25|98.82|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|137.25||||137.25|82.35|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|137.25||||137.25|96.08|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|137.25||||137.25|83.72|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|137.25||||137.25|37.1|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137.25||||137.25||98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|137.25||||137.25|94.7|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|137.25||||137.25|82.35|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|137.25||||137.25|68.63|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|137.25||||137.25|94.7|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|137.25||||137.25|64.51|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137.25||||137.25|94.7|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137.25||||137.25||98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|137.25||||137.25|94.84|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|137.25||||137.25|37.1|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137.25||||137.25||98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|137.25||||137.25|94.84|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137.25||||137.25|37.1|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|137.25||||137.25|94.7|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|137.25||||137.25|37.1|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|Self-pay|Self-pay|137.25||||137.25|27.45|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|TML [1980]|TML [198000]|137.25||||137.25|94.7|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|137.25||||137.25|23.33|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|137.25||||137.25|68.63|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|137.25||||137.25|68.63|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137.25||||137.25||98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|137.25||||137.25|68.63|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|137.25||||137.25|94.7|98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|137.25||||137.25||98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|137.25||||137.25||98.82|23.33
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|137.25||||137.25|68.63|98.82|23.33
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|AARP [1000]|AARP [100000]|137.25||||137.25|68.63|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137.25||||137.25||98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|AETNA [1015]|AETNA [101529]|137.25||||137.25|94.84|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|AMBETTER [2930]|AMBETTER [293000]|137.25||||137.25||98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|137.25||||137.25|37.1|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137.25||||137.25||98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|137.25||||137.25|64.51|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|137.25||||137.25|37.1|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137.25||||137.25||98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|137.25||||137.25|98.82|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|137.25||||137.25|82.35|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|137.25||||137.25|96.08|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|137.25||||137.25|83.72|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|137.25||||137.25|37.1|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137.25||||137.25||98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|137.25||||137.25|94.7|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|CIGNA [1260]|CIGNA PPO [126025]|137.25||||137.25|82.35|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|137.25||||137.25|68.63|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|GROUP PENSION ADMIN [1450]|GPA [145000]|137.25||||137.25|94.7|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|137.25||||137.25|64.51|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137.25||||137.25|94.7|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137.25||||137.25||98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|137.25||||137.25|94.84|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|137.25||||137.25|37.1|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137.25||||137.25||98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|137.25||||137.25|94.84|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137.25||||137.25|37.1|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|PHCS [1780]|PHCS MULTIPLAN [178000]|137.25||||137.25|94.7|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|137.25||||137.25|37.1|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|Self-pay|Self-pay|137.25||||137.25|27.45|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|TML [1980]|TML [198000]|137.25||||137.25|94.7|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|137.25||||137.25|23.33|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|137.25||||137.25|68.63|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|UNICARE [2040]|UNICARE [204000]|137.25||||137.25|68.63|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137.25||||137.25||98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|137.25||||137.25|68.63|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|WEB TPA [2115]|WEB TPA [211500]|137.25||||137.25|94.7|98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|137.25||||137.25||98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|137.25||||137.25||98.82|23.33
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|WORKER'S COMP [2125]|TML WC [212537]|137.25||||137.25|68.63|98.82|23.33
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|AARP [1000]|AARP [100000]|930||||930|465|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930||||930||669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|AETNA [1015]|AETNA [101529]|930||||930|642.63|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|AMBETTER [2930]|AMBETTER [293000]|930||||930||669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|251.38|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|930||||930|437.1|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|930||||930|251.38|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930||||930||669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|930||||930|669.6|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|930||||930|558|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|930||||930|651|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|930||||930|567.3|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|930||||930|251.38|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930||||930||669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|930||||930|641.7|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA PPO [126025]|930||||930|558|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|930||||930|465|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|GROUP PENSION ADMIN [1450]|GPA [145000]|930||||930|641.7|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|930||||930|437.1|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|641.7|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|930||||930|642.63|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|251.38|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|930||||930|642.63|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930||||930|251.38|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|PHCS [1780]|PHCS MULTIPLAN [178000]|930||||930|641.7|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|930||||930|251.38|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|Self-pay|Self-pay|930||||930|186|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|TML [1980]|TML [198000]|930||||930|641.7|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|930||||930|158.1|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|465|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|UNICARE [2040]|UNICARE [204000]|930||||930|465|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|930||||930|465|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|641.7|669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930||669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|930||||930||669.6|158.1
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|1|WORKER'S COMP [2125]|TML WC [212537]|930||||930|465|669.6|158.1
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AARP [1000]|AARP [100000]|137.25||||137.25|68.63|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137.25||||137.25||98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|137.25||||137.25|94.84|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|137.25||||137.25||98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|137.25||||137.25|37.1|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137.25||||137.25||98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|137.25||||137.25|64.51|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|137.25||||137.25|37.1|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137.25||||137.25||98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|137.25||||137.25|98.82|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|137.25||||137.25|82.35|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|137.25||||137.25|96.08|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|137.25||||137.25|83.72|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|137.25||||137.25|37.1|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137.25||||137.25||98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|137.25||||137.25|94.7|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|137.25||||137.25|82.35|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|137.25||||137.25|68.63|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|137.25||||137.25|94.7|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|137.25||||137.25|64.51|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137.25||||137.25|94.7|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137.25||||137.25||98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|137.25||||137.25|94.84|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|137.25||||137.25|37.1|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137.25||||137.25||98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|137.25||||137.25|94.84|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137.25||||137.25|37.1|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|137.25||||137.25|94.7|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|137.25||||137.25|37.1|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|Self-pay|Self-pay|137.25||||137.25|27.45|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|TML [1980]|TML [198000]|137.25||||137.25|94.7|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|137.25||||137.25|23.33|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|137.25||||137.25|68.63|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|137.25||||137.25|68.63|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137.25||||137.25||98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|137.25||||137.25|68.63|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|137.25||||137.25|94.7|98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|137.25||||137.25||98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|137.25||||137.25||98.82|23.33
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|137.25||||137.25|68.63|98.82|23.33
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|AARP [1000]|AARP [100000]|3491.25||||3491.25|1745.63|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3491.25||||3491.25||2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|AETNA [1015]|AETNA [101529]|3491.25||||3491.25|2412.45|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|AMBETTER [2930]|AMBETTER [293000]|3491.25||||3491.25||2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3491.25||||3491.25|943.68|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3491.25||||3491.25||2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|3491.25||||3491.25|1640.89|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|3491.25||||3491.25|943.68|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3491.25||||3491.25||2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|3491.25||||3491.25|2513.7|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|3491.25||||3491.25|2094.75|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|3491.25||||3491.25|2443.88|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|3491.25||||3491.25|2129.66|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|3491.25||||3491.25|943.68|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3491.25||||3491.25||2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|3491.25||||3491.25|2408.96|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|CIGNA [1260]|CIGNA PPO [126025]|3491.25||||3491.25|2094.75|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|3491.25||||3491.25|1745.63|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|GROUP PENSION ADMIN [1450]|GPA [145000]|3491.25||||3491.25|2408.96|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|3491.25||||3491.25|1640.89|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3491.25||||3491.25|2408.96|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3491.25||||3491.25||2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|3491.25||||3491.25|2412.45|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|3491.25||||3491.25|943.68|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3491.25||||3491.25||2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|3491.25||||3491.25|2412.45|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3491.25||||3491.25|943.68|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|PHCS [1780]|PHCS MULTIPLAN [178000]|3491.25||||3491.25|2408.96|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|3491.25||||3491.25|943.68|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|Self-pay|Self-pay|3491.25||||3491.25|698.25|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|TML [1980]|TML [198000]|3491.25||||3491.25|2408.96|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|3491.25||||3491.25|593.51|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|3491.25||||3491.25|1745.63|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|UNICARE [2040]|UNICARE [204000]|3491.25||||3491.25|1745.63|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3491.25||||3491.25||2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|3491.25||||3491.25|1745.63|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|WEB TPA [2115]|WEB TPA [211500]|3491.25||||3491.25|2408.96|2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|3491.25||||3491.25||2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|3491.25||||3491.25||2513.7|593.51
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|WORKER'S COMP [2125]|TML WC [212537]|3491.25||||3491.25|1745.63|2513.7|593.51
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|AARP [1000]|AARP [100000]|356.25||||356.25|178.13|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|356.25||||356.25||256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|AETNA [1015]|AETNA [101529]|356.25||||356.25|246.17|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|AMBETTER [2930]|AMBETTER [293000]|356.25||||356.25||256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|356.25||||356.25|96.29|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|356.25||||356.25||256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|356.25||||356.25|167.44|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|356.25||||356.25|96.29|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|356.25||||356.25||256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|356.25||||356.25|256.5|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|356.25||||356.25|213.75|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|356.25||||356.25|249.38|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|356.25||||356.25|217.31|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|356.25||||356.25|96.29|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|356.25||||356.25||256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|356.25||||356.25|245.81|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|CIGNA [1260]|CIGNA PPO [126025]|356.25||||356.25|213.75|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|356.25||||356.25|178.13|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|356.25||||356.25|245.81|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|356.25||||356.25|167.44|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|356.25||||356.25|245.81|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|356.25||||356.25||256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|356.25||||356.25|246.17|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|356.25||||356.25|96.29|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|356.25||||356.25||256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|356.25||||356.25|246.17|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|356.25||||356.25|96.29|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|356.25||||356.25|245.81|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|356.25||||356.25|96.29|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|Self-pay|Self-pay|356.25||||356.25|71.25|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|TML [1980]|TML [198000]|356.25||||356.25|245.81|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|356.25||||356.25|60.56|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|356.25||||356.25|178.13|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|UNICARE [2040]|UNICARE [204000]|356.25||||356.25|178.13|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|356.25||||356.25||256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|356.25||||356.25|178.13|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|WEB TPA [2115]|WEB TPA [211500]|356.25||||356.25|245.81|256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|356.25||||356.25||256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|356.25||||356.25||256.5|60.56
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|WORKER'S COMP [2125]|TML WC [212537]|356.25||||356.25|178.13|256.5|60.56
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|AARP [1000]|AARP [100000]|3491.25||||3491.25|1745.63|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3491.25||||3491.25||2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|AETNA [1015]|AETNA [101529]|3491.25||||3491.25|2412.45|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|AMBETTER [2930]|AMBETTER [293000]|3491.25||||3491.25||2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3491.25||||3491.25|943.68|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3491.25||||3491.25||2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|3491.25||||3491.25|1640.89|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|3491.25||||3491.25|943.68|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3491.25||||3491.25||2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|3491.25||||3491.25|2513.7|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|3491.25||||3491.25|2094.75|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|3491.25||||3491.25|2443.88|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|3491.25||||3491.25|2129.66|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|3491.25||||3491.25|943.68|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3491.25||||3491.25||2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|3491.25||||3491.25|2408.96|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|CIGNA [1260]|CIGNA PPO [126025]|3491.25||||3491.25|2094.75|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|3491.25||||3491.25|1745.63|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|GROUP PENSION ADMIN [1450]|GPA [145000]|3491.25||||3491.25|2408.96|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|3491.25||||3491.25|1640.89|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3491.25||||3491.25|2408.96|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3491.25||||3491.25||2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|3491.25||||3491.25|2412.45|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|3491.25||||3491.25|943.68|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3491.25||||3491.25||2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|3491.25||||3491.25|2412.45|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3491.25||||3491.25|943.68|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|PHCS [1780]|PHCS MULTIPLAN [178000]|3491.25||||3491.25|2408.96|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|3491.25||||3491.25|943.68|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|Self-pay|Self-pay|3491.25||||3491.25|698.25|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|TML [1980]|TML [198000]|3491.25||||3491.25|2408.96|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|3491.25||||3491.25|593.51|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|3491.25||||3491.25|1745.63|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|UNICARE [2040]|UNICARE [204000]|3491.25||||3491.25|1745.63|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3491.25||||3491.25||2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|3491.25||||3491.25|1745.63|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|WEB TPA [2115]|WEB TPA [211500]|3491.25||||3491.25|2408.96|2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|3491.25||||3491.25||2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|3491.25||||3491.25||2513.7|593.51
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|WORKER'S COMP [2125]|TML WC [212537]|3491.25||||3491.25|1745.63|2513.7|593.51
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|AARP [1000]|AARP [100000]|2850||||2850|1425|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2850||||2850||2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|AETNA [1015]|AETNA [101529]|2850||||2850|1969.35|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|AMBETTER [2930]|AMBETTER [293000]|2850||||2850||2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2850||||2850|770.36|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2850||||2850||2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|2850||||2850|1339.5|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2850||||2850|770.36|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2850||||2850||2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2850||||2850|2052|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|2850||||2850|1710|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2850||||2850|1995|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2850||||2850|1738.5|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2850||||2850|770.36|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2850||||2850||2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2850||||2850|1966.5|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|CIGNA [1260]|CIGNA PPO [126025]|2850||||2850|1710|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2850||||2850|1425|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|GROUP PENSION ADMIN [1450]|GPA [145000]|2850||||2850|1966.5|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|2850||||2850|1339.5|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2850||||2850|1966.5|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2850||||2850||2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2850||||2850|1969.35|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2850||||2850|770.36|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2850||||2850||2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2850||||2850|1969.35|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2850||||2850|770.36|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2850||||2850|1966.5|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2850||||2850|770.36|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|Self-pay|Self-pay|2850||||2850|570|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|TML [1980]|TML [198000]|2850||||2850|1966.5|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2850||||2850|484.5|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|2850||||2850|1425|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|UNICARE [2040]|UNICARE [204000]|2850||||2850|1425|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2850||||2850||2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2850||||2850|1425|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|WEB TPA [2115]|WEB TPA [211500]|2850||||2850|1966.5|2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|2850||||2850||2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2850||||2850||2052|484.5
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|WORKER'S COMP [2125]|TML WC [212537]|2850||||2850|1425|2052|484.5
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AARP [1000]|AARP [100000]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA [101529]|5.28||||5.28|3.65|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AMBETTER [2930]|AMBETTER [293000]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.28||||5.28|1.43|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|5.28||||5.28|2.64|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|5.28||||5.28|1.43|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|5.28||||5.28|3.8|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|5.28||||5.28|3.17|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|5.28||||5.28|3.7|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|5.28||||5.28|3.48|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|5.28||||5.28|1.43|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|CIGNA [1260]|CIGNA - GREAT WEST [126009]|5.28||||5.28|3.64|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|CIGNA [1260]|CIGNA PPO [126025]|5.28||||5.28|3.17|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA [145000]|5.28||||5.28|3.64|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|5.28||||5.28|2.64|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5.28||||5.28|3.64|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MAILHANDLERS [1595]|MAILHANDLERS [159500]|5.28||||5.28|3.65|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|5.28||||5.28|1.43|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|5.28||||5.28|3.65|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5.28||||5.28|1.43|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|PHCS [1780]|PHCS MULTIPLAN [178000]|5.28||||5.28|3.64|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|5.28||||5.28|1.43|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|Self-pay|Self-pay|5.28||||5.28|1.06|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|TML [1980]|TML [198000]|5.28||||5.28|3.64|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|5.28||||5.28|0.9|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UMR [2035]|UMR UNITED HEALTHCARE [203502]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UNICARE [2040]|UNICARE [204000]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|WEB TPA [2115]|WEB TPA [211500]|5.28||||5.28|3.64|54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|5.28||||5.28||54.67|0.9
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|TML WC [212537]|5.28||||5.28||54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|0.9
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|0.9
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|12.91
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|12.91
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AARP [1000]|AARP [100000]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA [101529]|19.74||||19.74|13.64|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AMBETTER [2930]|AMBETTER [293000]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|19.74||||19.74|5.34|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|19.74||||19.74|9.87|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|19.74||||19.74|5.34|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|19.74||||19.74|14.21|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|19.74||||19.74|11.84|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|19.74||||19.74|13.82|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|19.74||||19.74|13.03|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|19.74||||19.74|5.34|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CIGNA [1260]|CIGNA - GREAT WEST [126009]|19.74||||19.74|13.62|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CIGNA [1260]|CIGNA PPO [126025]|19.74||||19.74|11.84|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA [145000]|19.74||||19.74|13.62|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|19.74||||19.74|9.87|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.74||||19.74|13.62|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MAILHANDLERS [1595]|MAILHANDLERS [159500]|19.74||||19.74|13.64|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|19.74||||19.74|5.34|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|19.74||||19.74|13.64|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.74||||19.74|5.34|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|PHCS [1780]|PHCS MULTIPLAN [178000]|19.74||||19.74|13.62|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|19.74||||19.74|5.34|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|Self-pay|Self-pay|19.74||||19.74|3.95|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|TML [1980]|TML [198000]|19.74||||19.74|13.62|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|19.74||||19.74|3.36|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UMR [2035]|UMR UNITED HEALTHCARE [203502]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNICARE [2040]|UNICARE [204000]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|WEB TPA [2115]|WEB TPA [211500]|19.74||||19.74|13.62|54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|19.74||||19.74||54.67|3.36
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|TML WC [212537]|19.74||||19.74||54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AARP [1000]|AARP [100000]|75.93||||75.93|37.97|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.93||||75.93||54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AETNA [1015]|AETNA [101529]|75.93||||75.93|52.47|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AMBETTER [2930]|AMBETTER [293000]|75.93||||75.93||54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.93||||75.93|20.52|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.93||||75.93||54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|75.93||||75.93|35.69|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|75.93||||75.93|20.52|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.93||||75.93||54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|75.93||||75.93|54.67|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|75.93||||75.93|45.56|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|75.93||||75.93|53.15|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|75.93||||75.93|46.32|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|75.93||||75.93|20.52|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.93||||75.93||54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|75.93||||75.93|52.39|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CIGNA [1260]|CIGNA PPO [126025]|75.93||||75.93|45.56|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|75.93||||75.93|37.97|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|75.93||||75.93|52.39|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|75.93||||75.93|35.69|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.93||||75.93|52.39|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.93||||75.93||54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|75.93||||75.93|52.47|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|75.93||||75.93|20.52|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.93||||75.93||54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|75.93||||75.93|52.47|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.93||||75.93|20.52|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|75.93||||75.93|52.39|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|75.93||||75.93|20.52|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|Self-pay|Self-pay|75.93||||75.93|15.19|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|TML [1980]|TML [198000]|75.93||||75.93|52.39|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|75.93||||75.93|12.91|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|75.93||||75.93|37.97|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNICARE [2040]|UNICARE [204000]|75.93||||75.93|37.97|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.93||||75.93||54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|75.93||||75.93|37.97|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|WEB TPA [2115]|WEB TPA [211500]|75.93||||75.93|52.39|54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|75.93||||75.93||54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|75.93||||75.93||54.67|3.36
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|WORKER'S COMP [2125]|TML WC [212537]|75.93||||75.93|37.97|54.67|3.36
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AARP [1000]|AARP [100000]|76.5||||76.5|38.25|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.5||||76.5||55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|76.5||||76.5|52.86|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|76.5||||76.5||55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|76.5||||76.5|20.68|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.5||||76.5||55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|76.5||||76.5|35.96|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|76.5||||76.5|20.68|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.5||||76.5||55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|76.5||||76.5|55.08|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|76.5||||76.5|45.9|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|76.5||||76.5|53.55|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|76.5||||76.5|46.67|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|76.5||||76.5|20.68|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.5||||76.5||55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|76.5||||76.5|52.79|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|76.5||||76.5|45.9|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|76.5||||76.5|38.25|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|76.5||||76.5|52.79|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|76.5||||76.5|35.96|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.5||||76.5|52.79|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.5||||76.5||55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.5||||76.5|52.86|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|76.5||||76.5|20.68|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.5||||76.5||55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.5||||76.5|52.86|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.5||||76.5|20.68|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|76.5||||76.5|52.79|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|76.5||||76.5|20.68|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|76.5||||76.5|15.3|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TML [1980]|TML [198000]|76.5||||76.5|52.79|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|76.5||||76.5|13.01|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.5||||76.5|38.25|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|76.5||||76.5|38.25|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.5||||76.5||55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|76.5||||76.5|38.25|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|76.5||||76.5|52.79|55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.5||||76.5||55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|76.5||||76.5||55.08|13.01
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|76.5||||76.5|38.25|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AARP [1000]|AARP [100000]|76.5||||76.5|38.25|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.5||||76.5||55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|76.5||||76.5|52.86|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|76.5||||76.5||55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|76.5||||76.5|20.68|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.5||||76.5||55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|76.5||||76.5|35.96|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|76.5||||76.5|20.68|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.5||||76.5||55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|76.5||||76.5|55.08|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|76.5||||76.5|45.9|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|76.5||||76.5|53.55|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|76.5||||76.5|46.67|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|76.5||||76.5|20.68|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.5||||76.5||55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|76.5||||76.5|52.79|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|76.5||||76.5|45.9|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|76.5||||76.5|38.25|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|76.5||||76.5|52.79|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|76.5||||76.5|35.96|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.5||||76.5|52.79|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.5||||76.5||55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.5||||76.5|52.86|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|76.5||||76.5|20.68|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.5||||76.5||55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.5||||76.5|52.86|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.5||||76.5|20.68|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|76.5||||76.5|52.79|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|76.5||||76.5|20.68|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|76.5||||76.5|15.3|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TML [1980]|TML [198000]|76.5||||76.5|52.79|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|76.5||||76.5|13.01|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.5||||76.5|38.25|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|76.5||||76.5|38.25|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.5||||76.5||55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|76.5||||76.5|38.25|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|76.5||||76.5|52.79|55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.5||||76.5||55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|76.5||||76.5||55.08|13.01
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|76.5||||76.5|38.25|55.08|13.01
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AARP [1000]|AARP [100000]|459||||459|229.5|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|459||||459||330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AETNA [1015]|AETNA [101529]|459||||459|317.17|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AMBETTER [2930]|AMBETTER [293000]|459||||459||330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|459||||459|124.07|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|459||||459||330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|459||||459|229.5|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|459||||459|124.07|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|459||||459||330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|459||||459|330.48|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|459||||459|275.4|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|459||||459|321.3|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|459||||459|302.94|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|459||||459|124.07|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|459||||459||330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|459||||459|316.71|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|CIGNA [1260]|CIGNA PPO [126025]|459||||459|275.4|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|459||||459|229.5|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|GROUP PENSION ADMIN [1450]|GPA [145000]|459||||459|316.71|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|459||||459|229.5|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|459||||459|316.71|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|459||||459||330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|459||||459|317.17|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|459||||459|124.07|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|459||||459||330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|459||||459|317.17|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|459||||459|124.07|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|PHCS [1780]|PHCS MULTIPLAN [178000]|459||||459|316.71|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|459||||459|124.07|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|Self-pay|Self-pay|459||||459|91.8|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|TML [1980]|TML [198000]|459||||459|316.71|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|459||||459|78.03|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|459||||459|229.5|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|UNICARE [2040]|UNICARE [204000]|459||||459|229.5|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|459||||459||330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|459||||459|229.5|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|WEB TPA [2115]|WEB TPA [211500]|459||||459|316.71|330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|459||||459||330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|459||||459||330.48|78.03
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|WORKER'S COMP [2125]|TML WC [212537]|459||||459|229.5|330.48|78.03
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|AARP [1000]|AARP [100000]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|AETNA [1015]|AETNA [101529]|435||||435|300.59|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|AMBETTER [2930]|AMBETTER [293000]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|435||||435|117.58|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|435||||435|217.5|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|435||||435|117.58|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|435||||435|313.2|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|435||||435|261|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|435||||435|304.5|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|435||||435|287.1|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|435||||435|117.58|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|435||||435|300.15|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|CIGNA [1260]|CIGNA PPO [126025]|435||||435|261|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|435||||435|300.15|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|435||||435|217.5|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|435||||435|300.15|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|435||||435|300.59|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|435||||435|117.58|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|435||||435|300.59|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|435||||435|117.58|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|435||||435|300.15|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|435||||435|117.58|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|Self-pay|Self-pay|435||||435|87|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|TML [1980]|TML [198000]|435||||435|300.15|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|435||||435|73.95|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|UNICARE [2040]|UNICARE [204000]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|WEB TPA [2115]|WEB TPA [211500]|435||||435|300.15|313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|435||||435||313.2|73.95
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|WORKER'S COMP [2125]|TML WC [212537]|435||||435||313.2|73.95
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|AARP [1000]|AARP [100000]|324||||324|162|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|324||||324||233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|AETNA [1015]|AETNA [101529]|324||||324|223.88|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|AMBETTER [2930]|AMBETTER [293000]|324||||324||233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|324||||324|87.58|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|324||||324||233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|324||||324|152.28|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|324||||324|87.58|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|324||||324||233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|324||||324|233.28|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|324||||324|194.4|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|324||||324|226.8|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|324||||324|197.64|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|324||||324|87.58|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|324||||324||233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|324||||324|223.56|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|CIGNA [1260]|CIGNA PPO [126025]|324||||324|194.4|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|324||||324|162|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|GROUP PENSION ADMIN [1450]|GPA [145000]|324||||324|223.56|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|324||||324|152.28|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|324||||324|223.56|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|324||||324||233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|324||||324|223.88|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|324||||324|87.58|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|324||||324||233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|324||||324|223.88|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|324||||324|87.58|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|PHCS [1780]|PHCS MULTIPLAN [178000]|324||||324|223.56|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|324||||324|87.58|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|Self-pay|Self-pay|324||||324|64.8|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|TML [1980]|TML [198000]|324||||324|223.56|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|324||||324|55.08|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|324||||324|162|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|UNICARE [2040]|UNICARE [204000]|324||||324|162|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|324||||324||233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|324||||324|162|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|WEB TPA [2115]|WEB TPA [211500]|324||||324|223.56|233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|324||||324||233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|324||||324||233.28|55.08
100467|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM L55 MM OD5.5 MM ANKLE CANCELLOUS|1|WORKER'S COMP [2125]|TML WC [212537]|324||||324|162|233.28|55.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AARP [1000]|AARP [100000]|76.5||||76.5|38.25|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.5||||76.5||55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|76.5||||76.5|52.86|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|76.5||||76.5||55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|76.5||||76.5|20.68|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.5||||76.5||55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|76.5||||76.5|35.96|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|76.5||||76.5|20.68|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.5||||76.5||55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|76.5||||76.5|55.08|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|76.5||||76.5|45.9|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|76.5||||76.5|53.55|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|76.5||||76.5|46.67|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|76.5||||76.5|20.68|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.5||||76.5||55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|76.5||||76.5|52.79|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|76.5||||76.5|45.9|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|76.5||||76.5|38.25|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|76.5||||76.5|52.79|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|76.5||||76.5|35.96|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.5||||76.5|52.79|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.5||||76.5||55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.5||||76.5|52.86|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|76.5||||76.5|20.68|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.5||||76.5||55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.5||||76.5|52.86|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.5||||76.5|20.68|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|76.5||||76.5|52.79|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|76.5||||76.5|20.68|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|76.5||||76.5|15.3|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TML [1980]|TML [198000]|76.5||||76.5|52.79|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|76.5||||76.5|13.01|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.5||||76.5|38.25|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|76.5||||76.5|38.25|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.5||||76.5||55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|76.5||||76.5|38.25|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|76.5||||76.5|52.79|55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.5||||76.5||55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|76.5||||76.5||55.08|13.01
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|76.5||||76.5|38.25|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AARP [1000]|AARP [100000]|76.5||||76.5|38.25|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.5||||76.5||55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|76.5||||76.5|52.86|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|76.5||||76.5||55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|76.5||||76.5|20.68|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.5||||76.5||55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|76.5||||76.5|35.96|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|76.5||||76.5|20.68|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.5||||76.5||55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|76.5||||76.5|55.08|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|76.5||||76.5|45.9|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|76.5||||76.5|53.55|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|76.5||||76.5|46.67|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|76.5||||76.5|20.68|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.5||||76.5||55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|76.5||||76.5|52.79|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|76.5||||76.5|45.9|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|76.5||||76.5|38.25|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|76.5||||76.5|52.79|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|76.5||||76.5|35.96|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.5||||76.5|52.79|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.5||||76.5||55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.5||||76.5|52.86|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|76.5||||76.5|20.68|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.5||||76.5||55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.5||||76.5|52.86|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.5||||76.5|20.68|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|76.5||||76.5|52.79|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|76.5||||76.5|20.68|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|76.5||||76.5|15.3|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TML [1980]|TML [198000]|76.5||||76.5|52.79|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|76.5||||76.5|13.01|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.5||||76.5|38.25|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|76.5||||76.5|38.25|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.5||||76.5||55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|76.5||||76.5|38.25|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|76.5||||76.5|52.79|55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.5||||76.5||55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|76.5||||76.5||55.08|13.01
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|76.5||||76.5|38.25|55.08|13.01
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|AARP [1000]|AARP [100000]|4252.56||||4252.56|2126.28|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4252.56||||4252.56||3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|AETNA [1015]|AETNA [101529]|4252.56||||4252.56|2938.52|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|AMBETTER [2930]|AMBETTER [293000]|4252.56||||4252.56||3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|4252.56||||4252.56|1149.47|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4252.56||||4252.56||3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|4252.56||||4252.56|1998.7|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|4252.56||||4252.56|1149.47|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4252.56||||4252.56||3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|4252.56||||4252.56|3061.84|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|4252.56||||4252.56|2551.54|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|4252.56||||4252.56|2976.79|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|4252.56||||4252.56|2594.06|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|4252.56||||4252.56|1149.47|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4252.56||||4252.56||3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|4252.56||||4252.56|2934.27|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|CIGNA [1260]|CIGNA PPO [126025]|4252.56||||4252.56|2551.54|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|4252.56||||4252.56|2126.28|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|4252.56||||4252.56|2934.27|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|4252.56||||4252.56|1998.7|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4252.56||||4252.56|2934.27|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4252.56||||4252.56||3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4252.56||||4252.56|2938.52|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|4252.56||||4252.56|1149.47|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4252.56||||4252.56||3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4252.56||||4252.56|2938.52|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4252.56||||4252.56|1149.47|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|4252.56||||4252.56|2934.27|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|4252.56||||4252.56|1149.47|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|Self-pay|Self-pay|4252.56||||4252.56|850.51|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|TML [1980]|TML [198000]|4252.56||||4252.56|2934.27|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|4252.56||||4252.56|722.94|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4252.56||||4252.56|2126.28|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|UNICARE [2040]|UNICARE [204000]|4252.56||||4252.56|2126.28|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4252.56||||4252.56||3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|4252.56||||4252.56|2126.28|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|WEB TPA [2115]|WEB TPA [211500]|4252.56||||4252.56|2934.27|3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4252.56||||4252.56||3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|4252.56||||4252.56||3061.84|722.94
100484|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE 97MM TITANIUM 6 HOLE AXSOS 3 BONE TIBIAL LEFT PROXIMAL MEDIAL NONSTERILE|1|WORKER'S COMP [2125]|TML WC [212537]|4252.56||||4252.56|2126.28|3061.84|722.94
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|AARP [1000]|AARP [100000]|246.84||||246.84|123.42|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|246.84||||246.84||177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|AETNA [101529]|246.84||||246.84|170.57|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|AMBETTER [2930]|AMBETTER [293000]|246.84||||246.84||177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|246.84||||246.84|66.72|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|246.84||||246.84||177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|246.84||||246.84|4.32|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|246.84||||246.84|66.72|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|246.84||||246.84||177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|246.84||||246.84|177.72|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|246.84||||246.84|0|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|246.84||||246.84|172.79|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|246.84||||246.84|0|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|246.84||||246.84|66.72|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|246.84||||246.84||177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|246.84||||246.84|170.32|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|CIGNA [1260]|CIGNA PPO [126025]|246.84||||246.84|148.1|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|246.84||||246.84|123.42|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|GROUP PENSION ADMIN [1450]|GPA [145000]|246.84||||246.84|170.32|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|246.84||||246.84|4.32|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|246.84||||246.84|170.32|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|246.84||||246.84||177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|246.84||||246.84|170.57|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|246.84||||246.84|66.72|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|246.84||||246.84||177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|246.84||||246.84|170.57|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|246.84||||246.84|66.72|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|PHCS [1780]|PHCS MULTIPLAN [178000]|246.84||||246.84|170.32|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|246.84||||246.84|66.72|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|Self-pay|Self-pay|246.84||||246.84|49.37|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|TML [1980]|TML [198000]|246.84||||246.84|170.32|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|246.84||||246.84|41.96|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|UMR [2035]|UMR UNITED HEALTHCARE [203502]|246.84||||246.84|123.42|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|UNICARE [2040]|UNICARE [204000]|246.84||||246.84|123.42|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|246.84||||246.84||177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|246.84||||246.84|123.42|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|WEB TPA [2115]|WEB TPA [211500]|246.84||||246.84|170.32|177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|246.84||||246.84||177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|246.84||||246.84||177.72|4.32
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|WORKER'S COMP [2125]|TML WC [212537]|246.84||||246.84|123.42|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AARP [1000]|AARP [100000]|76.5||||76.5|38.25|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.5||||76.5||177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|76.5||||76.5|52.86|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|76.5||||76.5||177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|76.5||||76.5|20.68|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.5||||76.5||177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|76.5||||76.5|35.96|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|76.5||||76.5|20.68|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.5||||76.5||177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|76.5||||76.5|55.08|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|76.5||||76.5|45.9|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|76.5||||76.5|53.55|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|76.5||||76.5|46.67|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|76.5||||76.5|20.68|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.5||||76.5||177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|76.5||||76.5|52.79|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|76.5||||76.5|45.9|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|76.5||||76.5|38.25|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|76.5||||76.5|52.79|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|76.5||||76.5|35.96|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.5||||76.5|52.79|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.5||||76.5||177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.5||||76.5|52.86|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|76.5||||76.5|20.68|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.5||||76.5||177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.5||||76.5|52.86|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.5||||76.5|20.68|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|76.5||||76.5|52.79|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|76.5||||76.5|20.68|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|76.5||||76.5|15.3|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TML [1980]|TML [198000]|76.5||||76.5|52.79|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|76.5||||76.5|13.01|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.5||||76.5|38.25|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|76.5||||76.5|38.25|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.5||||76.5||177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|76.5||||76.5|38.25|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|76.5||||76.5|52.79|177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.5||||76.5||177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|76.5||||76.5||177.72|4.32
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|76.5||||76.5|38.25|177.72|4.32
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|AARP [1000]|AARP [100000]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|AETNA [1015]|AETNA [101529]|28.47||||28.47|19.67|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|AMBETTER [2930]|AMBETTER [293000]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|28.47||||28.47|7.7|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|28.47||||28.47|14.24|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|28.47||||28.47|7.7|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|28.47||||28.47|20.5|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|28.47||||28.47|17.08|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|28.47||||28.47|19.93|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|28.47||||28.47|18.79|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|28.47||||28.47|7.7|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|28.47||||28.47|19.64|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|CIGNA [1260]|CIGNA PPO [126025]|28.47||||28.47|17.08|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|28.47||||28.47|19.64|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|28.47||||28.47|14.24|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28.47||||28.47|19.64|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|28.47||||28.47|19.67|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|28.47||||28.47|7.7|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|28.47||||28.47|19.67|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28.47||||28.47|7.7|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|28.47||||28.47|19.64|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|28.47||||28.47|7.7|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|Self-pay|Self-pay|28.47||||28.47|5.69|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|TML [1980]|TML [198000]|28.47||||28.47|19.64|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|28.47||||28.47|4.84|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|UNICARE [2040]|UNICARE [204000]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|WEB TPA [2115]|WEB TPA [211500]|28.47||||28.47|19.64|20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|28.47||||28.47||20.5|4.84
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|WORKER'S COMP [2125]|TML WC [212537]|28.47||||28.47||20.5|4.84
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AARP [1000]|AARP [100000]|76.5||||76.5|38.25|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.5||||76.5||55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|76.5||||76.5|52.86|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|76.5||||76.5||55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|76.5||||76.5|20.68|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.5||||76.5||55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|76.5||||76.5|35.96|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|76.5||||76.5|20.68|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.5||||76.5||55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|76.5||||76.5|55.08|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|76.5||||76.5|45.9|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|76.5||||76.5|53.55|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|76.5||||76.5|46.67|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|76.5||||76.5|20.68|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.5||||76.5||55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|76.5||||76.5|52.79|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|76.5||||76.5|45.9|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|76.5||||76.5|38.25|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|76.5||||76.5|52.79|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|76.5||||76.5|35.96|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.5||||76.5|52.79|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.5||||76.5||55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.5||||76.5|52.86|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|76.5||||76.5|20.68|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.5||||76.5||55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.5||||76.5|52.86|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.5||||76.5|20.68|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|76.5||||76.5|52.79|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|76.5||||76.5|20.68|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|76.5||||76.5|15.3|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TML [1980]|TML [198000]|76.5||||76.5|52.79|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|76.5||||76.5|13.01|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.5||||76.5|38.25|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|76.5||||76.5|38.25|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.5||||76.5||55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|76.5||||76.5|38.25|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|76.5||||76.5|52.79|55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.5||||76.5||55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|76.5||||76.5||55.08|13.01
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|76.5||||76.5|38.25|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AARP [1000]|AARP [100000]|76.5||||76.5|38.25|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.5||||76.5||55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|76.5||||76.5|52.86|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|76.5||||76.5||55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|76.5||||76.5|20.68|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.5||||76.5||55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|76.5||||76.5|35.96|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|76.5||||76.5|20.68|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.5||||76.5||55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|76.5||||76.5|55.08|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|76.5||||76.5|45.9|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|76.5||||76.5|53.55|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|76.5||||76.5|46.67|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|76.5||||76.5|20.68|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.5||||76.5||55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|76.5||||76.5|52.79|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|76.5||||76.5|45.9|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|76.5||||76.5|38.25|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|76.5||||76.5|52.79|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|76.5||||76.5|35.96|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.5||||76.5|52.79|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.5||||76.5||55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.5||||76.5|52.86|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|76.5||||76.5|20.68|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.5||||76.5||55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.5||||76.5|52.86|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.5||||76.5|20.68|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|76.5||||76.5|52.79|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|76.5||||76.5|20.68|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|76.5||||76.5|15.3|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TML [1980]|TML [198000]|76.5||||76.5|52.79|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|76.5||||76.5|13.01|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.5||||76.5|38.25|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|76.5||||76.5|38.25|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.5||||76.5||55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|76.5||||76.5|38.25|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|76.5||||76.5|52.79|55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.5||||76.5||55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|76.5||||76.5||55.08|13.01
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|76.5||||76.5|38.25|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AARP [1000]|AARP [100000]|76.5||||76.5|38.25|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.5||||76.5||55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|76.5||||76.5|52.86|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|76.5||||76.5||55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|76.5||||76.5|20.68|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.5||||76.5||55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|76.5||||76.5|35.96|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|76.5||||76.5|20.68|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.5||||76.5||55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|76.5||||76.5|55.08|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|76.5||||76.5|45.9|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|76.5||||76.5|53.55|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|76.5||||76.5|46.67|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|76.5||||76.5|20.68|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.5||||76.5||55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|76.5||||76.5|52.79|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|76.5||||76.5|45.9|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|76.5||||76.5|38.25|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|76.5||||76.5|52.79|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|76.5||||76.5|35.96|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.5||||76.5|52.79|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.5||||76.5||55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.5||||76.5|52.86|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|76.5||||76.5|20.68|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.5||||76.5||55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.5||||76.5|52.86|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.5||||76.5|20.68|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|76.5||||76.5|52.79|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|76.5||||76.5|20.68|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|76.5||||76.5|15.3|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TML [1980]|TML [198000]|76.5||||76.5|52.79|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|76.5||||76.5|13.01|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.5||||76.5|38.25|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|76.5||||76.5|38.25|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.5||||76.5||55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|76.5||||76.5|38.25|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|76.5||||76.5|52.79|55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.5||||76.5||55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|76.5||||76.5||55.08|13.01
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|76.5||||76.5|38.25|55.08|13.01
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|AARP [1000]|AARP [100000]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|AETNA [1015]|AETNA [101529]|7101||||7101|4906.79|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|AMBETTER [2930]|AMBETTER [293000]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7101||||7101|1919.4|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|7101||||7101|3337.47|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|7101||||7101|1919.4|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|7101||||7101|5112.72|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|7101||||7101|4260.6|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|7101||||7101|4970.7|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|7101||||7101|4331.61|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|7101||||7101|1919.4|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|7101||||7101|4899.69|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|CIGNA [1260]|CIGNA PPO [126025]|7101||||7101|4260.6|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|GROUP PENSION ADMIN [1450]|GPA [145000]|7101||||7101|4899.69|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|7101||||7101|3337.47|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7101||||7101|4899.69|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7101||||7101|4906.79|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|7101||||7101|1919.4|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|7101||||7101|4906.79|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7101||||7101|1919.4|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|PHCS [1780]|PHCS MULTIPLAN [178000]|7101||||7101|4899.69|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|7101||||7101|1919.4|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|Self-pay|Self-pay|7101||||7101|1420.2|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|TML [1980]|TML [198000]|7101||||7101|4899.69|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|7101||||7101|1207.17|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|UNICARE [2040]|UNICARE [204000]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|WEB TPA [2115]|WEB TPA [211500]|7101||||7101|4899.69|5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|7101||||7101||5112.72|1207.17
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1|WORKER'S COMP [2125]|TML WC [212537]|7101||||7101||5112.72|1207.17
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AARP [1000]|AARP [100000]|76.5||||76.5|38.25|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.5||||76.5||55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|76.5||||76.5|52.86|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|76.5||||76.5||55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|76.5||||76.5|20.68|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.5||||76.5||55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|76.5||||76.5|35.96|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|76.5||||76.5|20.68|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.5||||76.5||55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|76.5||||76.5|55.08|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|76.5||||76.5|45.9|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|76.5||||76.5|53.55|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|76.5||||76.5|46.67|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|76.5||||76.5|20.68|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.5||||76.5||55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|76.5||||76.5|52.79|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|76.5||||76.5|45.9|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|76.5||||76.5|38.25|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|76.5||||76.5|52.79|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|76.5||||76.5|35.96|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.5||||76.5|52.79|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.5||||76.5||55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.5||||76.5|52.86|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|76.5||||76.5|20.68|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.5||||76.5||55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.5||||76.5|52.86|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.5||||76.5|20.68|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|76.5||||76.5|52.79|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|76.5||||76.5|20.68|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|76.5||||76.5|15.3|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TML [1980]|TML [198000]|76.5||||76.5|52.79|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|76.5||||76.5|13.01|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.5||||76.5|38.25|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|76.5||||76.5|38.25|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.5||||76.5||55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|76.5||||76.5|38.25|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|76.5||||76.5|52.79|55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.5||||76.5||55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|76.5||||76.5||55.08|13.01
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|76.5||||76.5|38.25|55.08|13.01
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|AARP [1000]|AARP [100000]|17457.12||||17457.12|8728.56|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17457.12||||17457.12||12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|AETNA [1015]|AETNA [101529]|17457.12||||17457.12|12062.87|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|AMBETTER [2930]|AMBETTER [293000]|17457.12||||17457.12||12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17457.12||||17457.12||12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|17457.12||||17457.12|8204.85|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|17457.12||||17457.12|4718.66|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17457.12||||17457.12||12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|17457.12||||17457.12|12569.13|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|17457.12||||17457.12|10474.27|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|17457.12||||17457.12|12219.98|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|17457.12||||17457.12|10648.84|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17457.12||||17457.12||12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|17457.12||||17457.12|12045.41|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA [1260]|CIGNA PPO [126025]|17457.12||||17457.12|10474.27|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|17457.12||||17457.12|8728.56|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|17457.12||||17457.12|8204.85|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17457.12||||17457.12|12045.41|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17457.12||||17457.12||12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|17457.12||||17457.12|12062.87|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17457.12||||17457.12||12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|17457.12||||17457.12|12062.87|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|17457.12||||17457.12|4718.66|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|Self-pay|Self-pay|17457.12||||17457.12|3491.42|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|TML [1980]|TML [198000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|17457.12||||17457.12|2967.71|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|17457.12||||17457.12|8728.56|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|UNICARE [2040]|UNICARE [204000]|17457.12||||17457.12|8728.56|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17457.12||||17457.12||12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|17457.12||||17457.12|8728.56|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|WEB TPA [2115]|WEB TPA [211500]|17457.12||||17457.12|12045.41|12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|17457.12||||17457.12||12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|17457.12||||17457.12||12569.13|2967.71
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1|WORKER'S COMP [2125]|TML WC [212537]|17457.12||||17457.12|8728.56|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|AARP [1000]|AARP [100000]|17457.12||||17457.12|8728.56|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17457.12||||17457.12||12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|AETNA [1015]|AETNA [101529]|17457.12||||17457.12|12062.87|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|AMBETTER [2930]|AMBETTER [293000]|17457.12||||17457.12||12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17457.12||||17457.12||12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|17457.12||||17457.12|8204.85|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|17457.12||||17457.12|4718.66|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17457.12||||17457.12||12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|17457.12||||17457.12|12569.13|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|17457.12||||17457.12|10474.27|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|17457.12||||17457.12|12219.98|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|17457.12||||17457.12|10648.84|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17457.12||||17457.12||12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|17457.12||||17457.12|12045.41|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA [1260]|CIGNA PPO [126025]|17457.12||||17457.12|10474.27|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|17457.12||||17457.12|8728.56|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|17457.12||||17457.12|8204.85|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17457.12||||17457.12|12045.41|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17457.12||||17457.12||12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|17457.12||||17457.12|12062.87|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17457.12||||17457.12||12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|17457.12||||17457.12|12062.87|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|17457.12||||17457.12|4718.66|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|Self-pay|Self-pay|17457.12||||17457.12|3491.42|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|TML [1980]|TML [198000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|17457.12||||17457.12|2967.71|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|17457.12||||17457.12|8728.56|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|UNICARE [2040]|UNICARE [204000]|17457.12||||17457.12|8728.56|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17457.12||||17457.12||12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|17457.12||||17457.12|8728.56|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|WEB TPA [2115]|WEB TPA [211500]|17457.12||||17457.12|12045.41|12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|17457.12||||17457.12||12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|17457.12||||17457.12||12569.13|2967.71
100532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 4 KNEE LEFT TOTAL STABILIZE STERILE|1|WORKER'S COMP [2125]|TML WC [212537]|17457.12||||17457.12|8728.56|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|AARP [1000]|AARP [100000]|17457.12||||17457.12|8728.56|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17457.12||||17457.12||12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|AETNA [1015]|AETNA [101529]|17457.12||||17457.12|12062.87|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|AMBETTER [2930]|AMBETTER [293000]|17457.12||||17457.12||12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17457.12||||17457.12||12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|17457.12||||17457.12|8204.85|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|17457.12||||17457.12|4718.66|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17457.12||||17457.12||12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|17457.12||||17457.12|12569.13|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|17457.12||||17457.12|10474.27|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|17457.12||||17457.12|12219.98|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|17457.12||||17457.12|10648.84|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17457.12||||17457.12||12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|17457.12||||17457.12|12045.41|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA [1260]|CIGNA PPO [126025]|17457.12||||17457.12|10474.27|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|17457.12||||17457.12|8728.56|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|17457.12||||17457.12|8204.85|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17457.12||||17457.12|12045.41|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17457.12||||17457.12||12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|17457.12||||17457.12|12062.87|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17457.12||||17457.12||12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|17457.12||||17457.12|12062.87|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|17457.12||||17457.12|4718.66|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|Self-pay|Self-pay|17457.12||||17457.12|3491.42|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|TML [1980]|TML [198000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|17457.12||||17457.12|2967.71|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|17457.12||||17457.12|8728.56|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|UNICARE [2040]|UNICARE [204000]|17457.12||||17457.12|8728.56|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17457.12||||17457.12||12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|17457.12||||17457.12|8728.56|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|WEB TPA [2115]|WEB TPA [211500]|17457.12||||17457.12|12045.41|12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|17457.12||||17457.12||12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|17457.12||||17457.12||12569.13|2967.71
100533|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE LEFT TOTAL STABILIZE STERILE|1|WORKER'S COMP [2125]|TML WC [212537]|17457.12||||17457.12|8728.56|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|AARP [1000]|AARP [100000]|17457.12||||17457.12|8728.56|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17457.12||||17457.12||12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|AETNA [1015]|AETNA [101529]|17457.12||||17457.12|12062.87|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|AMBETTER [2930]|AMBETTER [293000]|17457.12||||17457.12||12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17457.12||||17457.12||12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|17457.12||||17457.12|8204.85|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|17457.12||||17457.12|4718.66|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17457.12||||17457.12||12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|17457.12||||17457.12|12569.13|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|17457.12||||17457.12|10474.27|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|17457.12||||17457.12|12219.98|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|17457.12||||17457.12|10648.84|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17457.12||||17457.12||12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|17457.12||||17457.12|12045.41|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA [1260]|CIGNA PPO [126025]|17457.12||||17457.12|10474.27|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|17457.12||||17457.12|8728.56|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|17457.12||||17457.12|8204.85|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17457.12||||17457.12|12045.41|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17457.12||||17457.12||12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|17457.12||||17457.12|12062.87|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17457.12||||17457.12||12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|17457.12||||17457.12|12062.87|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|17457.12||||17457.12|4718.66|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|Self-pay|Self-pay|17457.12||||17457.12|3491.42|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|TML [1980]|TML [198000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|17457.12||||17457.12|2967.71|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|17457.12||||17457.12|8728.56|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|UNICARE [2040]|UNICARE [204000]|17457.12||||17457.12|8728.56|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17457.12||||17457.12||12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|17457.12||||17457.12|8728.56|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|WEB TPA [2115]|WEB TPA [211500]|17457.12||||17457.12|12045.41|12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|17457.12||||17457.12||12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|17457.12||||17457.12||12569.13|2967.71
100534|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE LEFT TOTAL STABILIZE STERILE|1|WORKER'S COMP [2125]|TML WC [212537]|17457.12||||17457.12|8728.56|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|AARP [1000]|AARP [100000]|17457.12||||17457.12|8728.56|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17457.12||||17457.12||12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|AETNA [1015]|AETNA [101529]|17457.12||||17457.12|12062.87|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|AMBETTER [2930]|AMBETTER [293000]|17457.12||||17457.12||12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17457.12||||17457.12||12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|17457.12||||17457.12|8204.85|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|17457.12||||17457.12|4718.66|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17457.12||||17457.12||12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|17457.12||||17457.12|12569.13|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|17457.12||||17457.12|10474.27|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|17457.12||||17457.12|12219.98|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|17457.12||||17457.12|10648.84|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17457.12||||17457.12||12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|17457.12||||17457.12|12045.41|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA [1260]|CIGNA PPO [126025]|17457.12||||17457.12|10474.27|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|17457.12||||17457.12|8728.56|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|17457.12||||17457.12|8204.85|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17457.12||||17457.12|12045.41|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17457.12||||17457.12||12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|17457.12||||17457.12|12062.87|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17457.12||||17457.12||12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|17457.12||||17457.12|12062.87|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17457.12||||17457.12|4718.66|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|17457.12||||17457.12|4718.66|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|Self-pay|Self-pay|17457.12||||17457.12|3491.42|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|TML [1980]|TML [198000]|17457.12||||17457.12|12045.41|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|17457.12||||17457.12|2967.71|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|17457.12||||17457.12|8728.56|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|UNICARE [2040]|UNICARE [204000]|17457.12||||17457.12|8728.56|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17457.12||||17457.12||12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|17457.12||||17457.12|8728.56|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|WEB TPA [2115]|WEB TPA [211500]|17457.12||||17457.12|12045.41|12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|17457.12||||17457.12||12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|17457.12||||17457.12||12569.13|2967.71
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|1|WORKER'S COMP [2125]|TML WC [212537]|17457.12||||17457.12|8728.56|12569.13|2967.71
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|AARP [1000]|AARP [100000]|23175.75||||23175.75|11587.88|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23175.75||||23175.75||16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|AETNA [1015]|AETNA [101529]|23175.75||||23175.75|16014.44|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|AMBETTER [2930]|AMBETTER [293000]|23175.75||||23175.75||16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|23175.75||||23175.75|6264.41|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23175.75||||23175.75||16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|23175.75||||23175.75|10892.6|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|23175.75||||23175.75|6264.41|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23175.75||||23175.75||16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|23175.75||||23175.75|16686.54|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|23175.75||||23175.75|13905.45|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|23175.75||||23175.75|16223.03|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|23175.75||||23175.75|14137.21|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|23175.75||||23175.75|6264.41|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23175.75||||23175.75||16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|23175.75||||23175.75|15991.27|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|CIGNA [1260]|CIGNA PPO [126025]|23175.75||||23175.75|13905.45|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|23175.75||||23175.75|11587.88|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|23175.75||||23175.75|15991.27|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|23175.75||||23175.75|10892.6|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23175.75||||23175.75|15991.27|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23175.75||||23175.75||16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|23175.75||||23175.75|16014.44|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|23175.75||||23175.75|6264.41|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23175.75||||23175.75||16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|23175.75||||23175.75|16014.44|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23175.75||||23175.75|6264.41|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|23175.75||||23175.75|15991.27|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|23175.75||||23175.75|6264.41|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|Self-pay|Self-pay|23175.75||||23175.75|4635.15|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|TML [1980]|TML [198000]|23175.75||||23175.75|15991.27|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|23175.75||||23175.75|3939.88|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|23175.75||||23175.75|11587.88|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|UNICARE [2040]|UNICARE [204000]|23175.75||||23175.75|11587.88|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23175.75||||23175.75||16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|23175.75||||23175.75|11587.88|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|WEB TPA [2115]|WEB TPA [211500]|23175.75||||23175.75|15991.27|16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|23175.75||||23175.75||16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|23175.75||||23175.75||16686.54|3939.88
100536|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 8 KNEE LEFT TOTAL STABILIZE STERILE|1|WORKER'S COMP [2125]|TML WC [212537]|23175.75||||23175.75|11587.88|16686.54|3939.88
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AARP [1000]|AARP [100000]|2190||||2190|1095|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2190||||2190||1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AETNA [1015]|AETNA [101529]|2190||||2190|1513.29|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMBETTER [2930]|AMBETTER [293000]|2190||||2190||1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2190||||2190|591.96|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2190||||2190||1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|2190||||2190|1029.3|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2190||||2190|591.96|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2190||||2190||1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2190||||2190|1576.8|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|2190||||2190|1314|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2190||||2190|1533|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2190||||2190|1335.9|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2190||||2190|591.96|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2190||||2190||1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2190||||2190|1511.1|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA [1260]|CIGNA PPO [126025]|2190||||2190|1314|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2190||||2190|1095|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|2190||||2190|1511.1|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|2190||||2190|1029.3|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2190||||2190|1511.1|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2190||||2190||1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2190||||2190|1513.29|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2190||||2190|591.96|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2190||||2190||1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2190||||2190|1513.29|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2190||||2190|591.96|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2190||||2190|1511.1|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2190||||2190|591.96|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|Self-pay|Self-pay|2190||||2190|438|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|TML [1980]|TML [198000]|2190||||2190|1511.1|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2190||||2190|372.3|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|2190||||2190|1095|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNICARE [2040]|UNICARE [204000]|2190||||2190|1095|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2190||||2190||1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2190||||2190|1095|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WEB TPA [2115]|WEB TPA [211500]|2190||||2190|1511.1|1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|2190||||2190||1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2190||||2190||1576.8|372.3
100539|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 3 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WORKER'S COMP [2125]|TML WC [212537]|2190||||2190|1095|1576.8|372.3
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AARP [1000]|AARP [100000]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AETNA [1015]|AETNA [101529]|7.79||||7.79|5.38|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AMBETTER [2930]|AMBETTER [293000]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.79||||7.79|2.11|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|7.79||||7.79|3.9|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|7.79||||7.79|2.11|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|7.79||||7.79|5.61|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|7.79||||7.79|4.67|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|7.79||||7.79|5.45|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|7.79||||7.79|5.14|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|7.79||||7.79|2.11|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CIGNA [1260]|CIGNA - GREAT WEST [126009]|7.79||||7.79|5.38|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CIGNA [1260]|CIGNA PPO [126025]|7.79||||7.79|4.67|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA [145000]|7.79||||7.79|5.38|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|7.79||||7.79|3.9|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7.79||||7.79|5.38|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7.79||||7.79|5.38|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|7.79||||7.79|2.11|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|7.79||||7.79|5.38|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7.79||||7.79|2.11|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|PHCS [1780]|PHCS MULTIPLAN [178000]|7.79||||7.79|5.38|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|7.79||||7.79|2.11|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|Self-pay|Self-pay|7.79||||7.79|1.56|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|TML [1980]|TML [198000]|7.79||||7.79|5.38|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|7.79||||7.79|1.32|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UMR [2035]|UMR UNITED HEALTHCARE [203502]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UNICARE [2040]|UNICARE [204000]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|WEB TPA [2115]|WEB TPA [211500]|7.79||||7.79|5.38|55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|7.79||||7.79||55.08|1.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|WORKER'S COMP [2125]|TML WC [212537]|7.79||||7.79||55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|AARP [1000]|AARP [100000]|76.5||||76.5|38.25|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.5||||76.5||55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|76.5||||76.5|52.86|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|76.5||||76.5||55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|76.5||||76.5|20.68|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.5||||76.5||55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|76.5||||76.5|35.96|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|76.5||||76.5|20.68|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.5||||76.5||55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|76.5||||76.5|55.08|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|76.5||||76.5|45.9|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|76.5||||76.5|53.55|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|76.5||||76.5|46.67|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|76.5||||76.5|20.68|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.5||||76.5||55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|76.5||||76.5|52.79|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|76.5||||76.5|45.9|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|76.5||||76.5|38.25|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|76.5||||76.5|52.79|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|76.5||||76.5|35.96|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.5||||76.5|52.79|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.5||||76.5||55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.5||||76.5|52.86|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|76.5||||76.5|20.68|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.5||||76.5||55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.5||||76.5|52.86|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.5||||76.5|20.68|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|76.5||||76.5|52.79|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|76.5||||76.5|20.68|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|Self-pay|Self-pay|76.5||||76.5|15.3|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|TML [1980]|TML [198000]|76.5||||76.5|52.79|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|76.5||||76.5|13.01|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.5||||76.5|38.25|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|76.5||||76.5|38.25|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.5||||76.5||55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|76.5||||76.5|38.25|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|76.5||||76.5|52.79|55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.5||||76.5||55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|76.5||||76.5||55.08|1.32
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|76.5||||76.5|38.25|55.08|1.32
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AARP [1000]|AARP [100000]|2190||||2190|1095|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2190||||2190||1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AETNA [1015]|AETNA [101529]|2190||||2190|1513.29|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMBETTER [2930]|AMBETTER [293000]|2190||||2190||1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2190||||2190|591.96|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2190||||2190||1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|2190||||2190|1029.3|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2190||||2190|591.96|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2190||||2190||1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2190||||2190|1576.8|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|2190||||2190|1314|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2190||||2190|1533|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2190||||2190|1335.9|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2190||||2190|591.96|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2190||||2190||1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2190||||2190|1511.1|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA [1260]|CIGNA PPO [126025]|2190||||2190|1314|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2190||||2190|1095|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|2190||||2190|1511.1|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|2190||||2190|1029.3|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2190||||2190|1511.1|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2190||||2190||1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2190||||2190|1513.29|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2190||||2190|591.96|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2190||||2190||1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2190||||2190|1513.29|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2190||||2190|591.96|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2190||||2190|1511.1|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2190||||2190|591.96|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|Self-pay|Self-pay|2190||||2190|438|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|TML [1980]|TML [198000]|2190||||2190|1511.1|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2190||||2190|372.3|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|2190||||2190|1095|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNICARE [2040]|UNICARE [204000]|2190||||2190|1095|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2190||||2190||1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2190||||2190|1095|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WEB TPA [2115]|WEB TPA [211500]|2190||||2190|1511.1|1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|2190||||2190||1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2190||||2190||1576.8|372.3
100540|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 4 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WORKER'S COMP [2125]|TML WC [212537]|2190||||2190|1095|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AARP [1000]|AARP [100000]|2190||||2190|1095|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2190||||2190||1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AETNA [1015]|AETNA [101529]|2190||||2190|1513.29|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMBETTER [2930]|AMBETTER [293000]|2190||||2190||1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2190||||2190|591.96|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2190||||2190||1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|2190||||2190|1029.3|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2190||||2190|591.96|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2190||||2190||1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2190||||2190|1576.8|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|2190||||2190|1314|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2190||||2190|1533|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2190||||2190|1335.9|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2190||||2190|591.96|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2190||||2190||1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2190||||2190|1511.1|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA [1260]|CIGNA PPO [126025]|2190||||2190|1314|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2190||||2190|1095|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|2190||||2190|1511.1|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|2190||||2190|1029.3|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2190||||2190|1511.1|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2190||||2190||1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2190||||2190|1513.29|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2190||||2190|591.96|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2190||||2190||1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2190||||2190|1513.29|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2190||||2190|591.96|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2190||||2190|1511.1|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2190||||2190|591.96|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|Self-pay|Self-pay|2190||||2190|438|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|TML [1980]|TML [198000]|2190||||2190|1511.1|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2190||||2190|372.3|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|2190||||2190|1095|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNICARE [2040]|UNICARE [204000]|2190||||2190|1095|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2190||||2190||1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2190||||2190|1095|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WEB TPA [2115]|WEB TPA [211500]|2190||||2190|1511.1|1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|2190||||2190||1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2190||||2190||1576.8|372.3
100541|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 5 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WORKER'S COMP [2125]|TML WC [212537]|2190||||2190|1095|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AARP [1000]|AARP [100000]|2190||||2190|1095|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2190||||2190||1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AETNA [1015]|AETNA [101529]|2190||||2190|1513.29|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMBETTER [2930]|AMBETTER [293000]|2190||||2190||1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2190||||2190|591.96|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2190||||2190||1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|2190||||2190|1029.3|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2190||||2190|591.96|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2190||||2190||1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2190||||2190|1576.8|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|2190||||2190|1314|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2190||||2190|1533|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2190||||2190|1335.9|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2190||||2190|591.96|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2190||||2190||1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2190||||2190|1511.1|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA [1260]|CIGNA PPO [126025]|2190||||2190|1314|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2190||||2190|1095|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|2190||||2190|1511.1|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|2190||||2190|1029.3|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2190||||2190|1511.1|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2190||||2190||1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2190||||2190|1513.29|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2190||||2190|591.96|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2190||||2190||1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2190||||2190|1513.29|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2190||||2190|591.96|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2190||||2190|1511.1|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2190||||2190|591.96|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|Self-pay|Self-pay|2190||||2190|438|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|TML [1980]|TML [198000]|2190||||2190|1511.1|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2190||||2190|372.3|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|2190||||2190|1095|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNICARE [2040]|UNICARE [204000]|2190||||2190|1095|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2190||||2190||1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2190||||2190|1095|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WEB TPA [2115]|WEB TPA [211500]|2190||||2190|1511.1|1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|2190||||2190||1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2190||||2190||1576.8|372.3
100542|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 6 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WORKER'S COMP [2125]|TML WC [212537]|2190||||2190|1095|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AARP [1000]|AARP [100000]|2190||||2190|1095|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2190||||2190||1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AETNA [1015]|AETNA [101529]|2190||||2190|1513.29|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMBETTER [2930]|AMBETTER [293000]|2190||||2190||1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2190||||2190|591.96|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2190||||2190||1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|2190||||2190|1029.3|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2190||||2190|591.96|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2190||||2190||1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2190||||2190|1576.8|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|2190||||2190|1314|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2190||||2190|1533|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2190||||2190|1335.9|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2190||||2190|591.96|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2190||||2190||1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2190||||2190|1511.1|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA [1260]|CIGNA PPO [126025]|2190||||2190|1314|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2190||||2190|1095|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|2190||||2190|1511.1|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|2190||||2190|1029.3|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2190||||2190|1511.1|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2190||||2190||1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2190||||2190|1513.29|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2190||||2190|591.96|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2190||||2190||1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2190||||2190|1513.29|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2190||||2190|591.96|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2190||||2190|1511.1|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2190||||2190|591.96|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|Self-pay|Self-pay|2190||||2190|438|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|TML [1980]|TML [198000]|2190||||2190|1511.1|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2190||||2190|372.3|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|2190||||2190|1095|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNICARE [2040]|UNICARE [204000]|2190||||2190|1095|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2190||||2190||1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2190||||2190|1095|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WEB TPA [2115]|WEB TPA [211500]|2190||||2190|1511.1|1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|2190||||2190||1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2190||||2190||1576.8|372.3
100543|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 7 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WORKER'S COMP [2125]|TML WC [212537]|2190||||2190|1095|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AARP [1000]|AARP [100000]|2190||||2190|1095|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2190||||2190||1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AETNA [1015]|AETNA [101529]|2190||||2190|1513.29|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMBETTER [2930]|AMBETTER [293000]|2190||||2190||1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2190||||2190|591.96|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2190||||2190||1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|2190||||2190|1029.3|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2190||||2190|591.96|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2190||||2190||1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2190||||2190|1576.8|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|2190||||2190|1314|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2190||||2190|1533|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2190||||2190|1335.9|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2190||||2190|591.96|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2190||||2190||1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2190||||2190|1511.1|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|CIGNA [1260]|CIGNA PPO [126025]|2190||||2190|1314|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2190||||2190|1095|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|2190||||2190|1511.1|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|2190||||2190|1029.3|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2190||||2190|1511.1|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2190||||2190||1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2190||||2190|1513.29|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2190||||2190|591.96|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2190||||2190||1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2190||||2190|1513.29|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2190||||2190|591.96|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|2190||||2190|1511.1|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2190||||2190|591.96|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|Self-pay|Self-pay|2190||||2190|438|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|TML [1980]|TML [198000]|2190||||2190|1511.1|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2190||||2190|372.3|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|2190||||2190|1095|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNICARE [2040]|UNICARE [204000]|2190||||2190|1095|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2190||||2190||1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2190||||2190|1095|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WEB TPA [2115]|WEB TPA [211500]|2190||||2190|1511.1|1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|2190||||2190||1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2190||||2190||1576.8|372.3
100544|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT TIBIAL TRIATHLON POLYETHYLENE 8 H9 MM KNEE CONDYLAR STABILIZE BEARING STERILE LATEX FREE|1|WORKER'S COMP [2125]|TML WC [212537]|2190||||2190|1095|1576.8|372.3
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AARP [1000]|AARP [100000]|76.5||||76.5|38.25|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.5||||76.5||55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|76.5||||76.5|52.86|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|76.5||||76.5||55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|76.5||||76.5|20.68|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.5||||76.5||55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|76.5||||76.5|35.96|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|76.5||||76.5|20.68|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.5||||76.5||55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|76.5||||76.5|55.08|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|76.5||||76.5|45.9|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|76.5||||76.5|53.55|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|76.5||||76.5|46.67|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|76.5||||76.5|20.68|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.5||||76.5||55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|76.5||||76.5|52.79|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|76.5||||76.5|45.9|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|76.5||||76.5|38.25|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|76.5||||76.5|52.79|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|76.5||||76.5|35.96|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.5||||76.5|52.79|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.5||||76.5||55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.5||||76.5|52.86|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|76.5||||76.5|20.68|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.5||||76.5||55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.5||||76.5|52.86|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.5||||76.5|20.68|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|76.5||||76.5|52.79|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|76.5||||76.5|20.68|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|76.5||||76.5|15.3|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TML [1980]|TML [198000]|76.5||||76.5|52.79|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|76.5||||76.5|13.01|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.5||||76.5|38.25|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|76.5||||76.5|38.25|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.5||||76.5||55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|76.5||||76.5|38.25|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|76.5||||76.5|52.79|55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.5||||76.5||55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|76.5||||76.5||55.08|13.01
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|76.5||||76.5|38.25|55.08|13.01
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|AARP [1000]|AARP [100000]|6921||||6921|3460.5|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6921||||6921||4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|AETNA [1015]|AETNA [101529]|6921||||6921|4782.41|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|AMBETTER [2930]|AMBETTER [293000]|6921||||6921||4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6921||||6921|1870.75|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6921||||6921||4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|6921||||6921|3252.87|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|6921||||6921|1870.75|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6921||||6921||4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|6921||||6921|4983.12|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|6921||||6921|4152.6|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|6921||||6921|4844.7|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|6921||||6921|4221.81|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|6921||||6921|1870.75|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6921||||6921||4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|6921||||6921|4775.49|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|CIGNA [1260]|CIGNA PPO [126025]|6921||||6921|4152.6|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|6921||||6921|3460.5|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|6921||||6921|4775.49|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|6921||||6921|3252.87|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6921||||6921|4775.49|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6921||||6921||4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|6921||||6921|4782.41|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|6921||||6921|1870.75|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6921||||6921||4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|6921||||6921|4782.41|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6921||||6921|1870.75|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|PHCS [1780]|PHCS MULTIPLAN [178000]|6921||||6921|4775.49|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|6921||||6921|1870.75|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|Self-pay|Self-pay|6921||||6921|1384.2|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|TML [1980]|TML [198000]|6921||||6921|4775.49|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|6921||||6921|1176.57|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|6921||||6921|3460.5|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|UNICARE [2040]|UNICARE [204000]|6921||||6921|3460.5|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6921||||6921||4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6921||||6921|3460.5|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|WEB TPA [2115]|WEB TPA [211500]|6921||||6921|4775.49|4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|6921||||6921||4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|6921||||6921||4983.12|1176.57
100567|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL SECUR-FIT ADVANCED PUREFIX TITANIUM 132 D 8 38.4 MM OFFSET L136 MM OD8.1 MM HIP PRESS FIT STERILE|1|WORKER'S COMP [2125]|TML WC [212537]|6921||||6921|3460.5|4983.12|1176.57
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AARP [1000]|AARP [100000]|76.5||||76.5|38.25|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.5||||76.5||55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|76.5||||76.5|52.86|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|76.5||||76.5||55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|76.5||||76.5|20.68|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.5||||76.5||55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|76.5||||76.5|35.96|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|76.5||||76.5|20.68|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.5||||76.5||55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|76.5||||76.5|55.08|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|76.5||||76.5|45.9|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|76.5||||76.5|53.55|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|76.5||||76.5|46.67|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|76.5||||76.5|20.68|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.5||||76.5||55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|76.5||||76.5|52.79|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|76.5||||76.5|45.9|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|76.5||||76.5|38.25|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|76.5||||76.5|52.79|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|76.5||||76.5|35.96|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.5||||76.5|52.79|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.5||||76.5||55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.5||||76.5|52.86|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|76.5||||76.5|20.68|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.5||||76.5||55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.5||||76.5|52.86|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.5||||76.5|20.68|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|76.5||||76.5|52.79|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|76.5||||76.5|20.68|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|76.5||||76.5|15.3|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TML [1980]|TML [198000]|76.5||||76.5|52.79|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|76.5||||76.5|13.01|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.5||||76.5|38.25|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|76.5||||76.5|38.25|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.5||||76.5||55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|76.5||||76.5|38.25|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|76.5||||76.5|52.79|55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.5||||76.5||55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|76.5||||76.5||55.08|13.01
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|76.5||||76.5|38.25|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AARP [1000]|AARP [100000]|76.5||||76.5|38.25|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76.5||||76.5||55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA [101529]|76.5||||76.5|52.86|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMBETTER [2930]|AMBETTER [293000]|76.5||||76.5||55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|76.5||||76.5|20.68|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76.5||||76.5||55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|76.5||||76.5|35.96|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|76.5||||76.5|20.68|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.5||||76.5||55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|76.5||||76.5|55.08|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|76.5||||76.5|45.9|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|76.5||||76.5|53.55|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|76.5||||76.5|46.67|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|76.5||||76.5|20.68|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76.5||||76.5||55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|76.5||||76.5|52.79|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA [1260]|CIGNA PPO [126025]|76.5||||76.5|45.9|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|76.5||||76.5|38.25|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|76.5||||76.5|52.79|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|76.5||||76.5|35.96|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76.5||||76.5|52.79|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.5||||76.5||55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.5||||76.5|52.86|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|76.5||||76.5|20.68|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76.5||||76.5||55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.5||||76.5|52.86|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76.5||||76.5|20.68|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|PHCS MULTIPLAN [178000]|76.5||||76.5|52.79|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|76.5||||76.5|20.68|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|76.5||||76.5|15.3|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TML [1980]|TML [198000]|76.5||||76.5|52.79|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|76.5||||76.5|13.01|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.5||||76.5|38.25|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNICARE [2040]|UNICARE [204000]|76.5||||76.5|38.25|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.5||||76.5||55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|76.5||||76.5|38.25|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WEB TPA [2115]|WEB TPA [211500]|76.5||||76.5|52.79|55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.5||||76.5||55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|76.5||||76.5||55.08|13.01
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|TML WC [212537]|76.5||||76.5|38.25|55.08|13.01
100581|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L40 MM OD3.5 MM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK COMPREHENSIVE FOOT SYSTEM|1|AARP [1000]|AARP [100000]|645||||645|322.5|464.4|109.65
100581|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L40 MM OD3.5 MM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK COMPREHENSIVE FOOT SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|645||||645||464.4|109.65
100581|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L40 MM OD3.5 MM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK COMPREHENSIVE FOOT SYSTEM|1|AETNA [1015]|AETNA [101529]|645||||645|445.7|464.4|109.65
100581|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L40 MM OD3.5 MM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK COMPREHENSIVE FOOT SYSTEM|1|AMBETTER [2930]|AMBETTER [293000]|645||||645||464.4|109.65
100581|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L40 MM OD3.5 MM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK COMPREHENSIVE FOOT SYSTEM|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|645||||645|174.34|464.4|109.65
100581|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L40 MM OD3.5 MM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK COMPREHENSIVE FOOT SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|645||||645||464.4|109.65
100581|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L40 MM OD3.5 MM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK COMPREHENSIVE FOOT SYSTEM|1|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|645||||645|303.15|464.4|109.65
100581|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L40 MM OD3.5 MM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK COMPREHENSIVE FOOT SYSTEM|1|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|645||||645|174.34|464.4|109.65
100581|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L40 MM OD3.5 MM MIDFOOT CORTICAL SELF TAP SOLID HEXALOBE LOCK COMPREHENSIVE FOOT SYSTEM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|645||||645||464.4|109.65
100581|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOW PROFILE SCREWS TITANIUM T15 FULL THREAD L40 MM OD3.5