"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|2452.68|436.03
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|490.54|2452.68|436.03
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA [101529]|2725.2||||2725.2|2180.16|2452.68|436.03
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AMBETTER [2930]|AMBETTER [293000]|2725.2||||2725.2|457.83|2452.68|436.03
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|996.61|2452.68|436.03
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|436.03|2452.68|436.03
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|2452.68|436.03
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|996.61|2452.68|436.03
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|436.03|2452.68|436.03
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|2452.68|436.03
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|2098.4|2452.68|436.03
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|2452.68|2452.68|436.03
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|2234.66|2452.68|436.03
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|996.61|2452.68|436.03
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|436.03|2452.68|436.03
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|2452.68|436.03
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|2452.68|436.03
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|2452.68|436.03
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|2452.68|436.03
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|2452.68|436.03
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|2452.68|436.03
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|436.03|2452.68|436.03
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2725.2||||2725.2|2180.16|2452.68|436.03
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|996.61|2452.68|436.03
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|436.03|2452.68|436.03
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|2180.16|2452.68|436.03
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|996.61|2452.68|436.03
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|2452.68|436.03
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|996.61|2452.68|436.03
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|2452.68|436.03
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|2452.68|436.03
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|626.8|2452.68|436.03
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|2452.68|436.03
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|2452.68|436.03
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|436.03|2452.68|436.03
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|2452.68|436.03
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|2452.68|436.03
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|436.03|2452.68|436.03
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|981.07|2452.68|436.03
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|2452.68|436.03
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|313.63|55.76
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|62.73|313.63|55.76
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|278.78|313.63|55.76
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|58.54|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|268.33|313.63|55.76
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|313.63|313.63|55.76
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|285.75|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|80.15|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|125.45|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|62.73|313.63|55.76
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|278.78|313.63|55.76
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|58.54|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|268.33|313.63|55.76
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|313.63|313.63|55.76
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|285.75|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|80.15|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|125.45|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|62.73|313.63|55.76
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|278.78|313.63|55.76
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|58.54|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|268.33|313.63|55.76
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|313.63|313.63|55.76
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|285.75|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|80.15|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|125.45|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|62.73|313.63|55.76
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|278.78|313.63|55.76
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|58.54|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|268.33|313.63|55.76
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|313.63|313.63|55.76
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|285.75|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|80.15|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|125.45|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|62.73|313.63|55.76
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|278.78|313.63|55.76
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|58.54|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|268.33|313.63|55.76
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|313.63|313.63|55.76
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|285.75|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|80.15|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|125.45|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|62.73|313.63|55.76
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|278.78|313.63|55.76
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|58.54|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|268.33|313.63|55.76
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|313.63|313.63|55.76
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|285.75|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|80.15|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|125.45|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|62.73|313.63|55.76
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|278.78|313.63|55.76
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|58.54|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|268.33|313.63|55.76
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|313.63|313.63|55.76
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|285.75|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|80.15|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|125.45|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|62.73|313.63|55.76
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|278.78|313.63|55.76
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|58.54|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|268.33|313.63|55.76
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|313.63|313.63|55.76
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|285.75|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|55.76|313.63|55.76
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|278.78|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|127.44|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|80.15|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|313.63|55.76
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|313.63|55.76
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|55.76|313.63|55.76
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|125.45|313.63|55.76
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|313.63|55.76
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|122.5|21.78
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|24.5|122.5|21.78
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|108.89|122.5|21.78
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|22.87|122.5|21.78
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|49.78|122.5|21.78
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|21.78|122.5|21.78
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|122.5|21.78
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|49.78|122.5|21.78
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|21.78|122.5|21.78
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|122.5|21.78
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|104.8|122.5|21.78
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|122.5|122.5|21.78
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|111.61|122.5|21.78
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|49.78|122.5|21.78
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|21.78|122.5|21.78
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|122.5|21.78
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|122.5|21.78
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|122.5|21.78
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|122.5|21.78
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|122.5|21.78
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|122.5|21.78
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|21.78|122.5|21.78
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|108.89|122.5|21.78
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|49.78|122.5|21.78
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|21.78|122.5|21.78
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|108.89|122.5|21.78
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|49.78|122.5|21.78
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|122.5|21.78
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|49.78|122.5|21.78
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|122.5|21.78
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|122.5|21.78
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|31.31|122.5|21.78
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|122.5|21.78
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|122.5|21.78
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|21.78|122.5|21.78
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|122.5|21.78
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|122.5|21.78
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|21.78|122.5|21.78
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|49|122.5|21.78
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|122.5|21.78
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|7490.07|1331.57
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|1498.01|7490.07|1331.57
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|6657.84|7490.07|1331.57
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|1398.15|7490.07|1331.57
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|3043.47|7490.07|1331.57
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|1331.57|7490.07|1331.57
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|7490.07|1331.57
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|3043.47|7490.07|1331.57
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|1331.57|7490.07|1331.57
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|7490.07|1331.57
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|6408.17|7490.07|1331.57
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|7490.07|7490.07|1331.57
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|6824.29|7490.07|1331.57
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|3043.47|7490.07|1331.57
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|1331.57|7490.07|1331.57
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|7490.07|1331.57
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|7490.07|1331.57
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|7490.07|1331.57
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|7490.07|1331.57
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|7490.07|1331.57
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|7490.07|1331.57
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|1331.57|7490.07|1331.57
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|6657.84|7490.07|1331.57
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|3043.47|7490.07|1331.57
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|1331.57|7490.07|1331.57
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|6657.84|7490.07|1331.57
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|3043.47|7490.07|1331.57
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|7490.07|1331.57
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|3043.47|7490.07|1331.57
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|7490.07|1331.57
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|7490.07|1331.57
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|1914.13|7490.07|1331.57
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|7490.07|1331.57
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|7490.07|1331.57
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|1331.57|7490.07|1331.57
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|7490.07|1331.57
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|7490.07|1331.57
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|1331.57|7490.07|1331.57
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|2996.03|7490.07|1331.57
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|7490.07|1331.57
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|1479.6|263.04
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|295.92|1479.6|263.04
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|1315.2|1479.6|263.04
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|276.19|1479.6|263.04
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|601.21|1479.6|263.04
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|263.04|1479.6|263.04
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|1479.6|263.04
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|601.21|1479.6|263.04
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|263.04|1479.6|263.04
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|1479.6|263.04
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|1265.88|1479.6|263.04
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|1479.6|1479.6|263.04
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|1348.08|1479.6|263.04
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|601.21|1479.6|263.04
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|263.04|1479.6|263.04
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|1479.6|263.04
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|1479.6|263.04
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|1479.6|263.04
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|1479.6|263.04
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|1479.6|263.04
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|1479.6|263.04
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|263.04|1479.6|263.04
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|1315.2|1479.6|263.04
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|601.21|1479.6|263.04
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|263.04|1479.6|263.04
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|1315.2|1479.6|263.04
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|601.21|1479.6|263.04
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|1479.6|263.04
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|601.21|1479.6|263.04
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|1479.6|263.04
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|1479.6|263.04
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|378.12|1479.6|263.04
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|1479.6|263.04
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|1479.6|263.04
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|263.04|1479.6|263.04
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|1479.6|263.04
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|1479.6|263.04
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|263.04|1479.6|263.04
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|591.84|1479.6|263.04
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|1479.6|263.04
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||2.35|0.42
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|0.47|2.35|0.42
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|2.09|2.35|0.42
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|0.44|2.35|0.42
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|0.95|2.35|0.42
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|0.42|2.35|0.42
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|2.35|0.42
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|0.95|2.35|0.42
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|0.42|2.35|0.42
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|2.35|0.42
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|2.01|2.35|0.42
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|2.35|2.35|0.42
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|2.19|2.35|0.42
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|0.95|2.35|0.42
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|0.42|2.35|0.42
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|2.35|0.42
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|2.35|0.42
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||2.35|0.42
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|2.35|0.42
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|2.35|0.42
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|2.35|0.42
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|0.42|2.35|0.42
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|2.09|2.35|0.42
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|0.95|2.35|0.42
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|0.42|2.35|0.42
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|2.09|2.35|0.42
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|0.95|2.35|0.42
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|2.35|0.42
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|0.95|2.35|0.42
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|2.35|0.42
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|2.35|0.42
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|0.6|2.35|0.42
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||2.35|0.42
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||2.35|0.42
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|0.42|2.35|0.42
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||2.35|0.42
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|2.35|0.42
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|0.42|2.35|0.42
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|0.94|2.35|0.42
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||2.35|0.42
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||2.35|0.42
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|0.47|2.35|0.42
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|2.09|2.35|0.42
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|0.44|2.35|0.42
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|0.95|2.35|0.42
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|0.42|2.35|0.42
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|2.35|0.42
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|0.95|2.35|0.42
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|0.42|2.35|0.42
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|2.35|0.42
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|2.01|2.35|0.42
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|2.35|2.35|0.42
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|2.19|2.35|0.42
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|0.95|2.35|0.42
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|0.42|2.35|0.42
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|2.35|0.42
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|2.35|0.42
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||2.35|0.42
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|2.35|0.42
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|2.35|0.42
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|2.35|0.42
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|0.42|2.35|0.42
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|2.09|2.35|0.42
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|0.95|2.35|0.42
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|0.42|2.35|0.42
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|2.09|2.35|0.42
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|0.95|2.35|0.42
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|2.35|0.42
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|0.95|2.35|0.42
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|2.35|0.42
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|2.35|0.42
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|0.6|2.35|0.42
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||2.35|0.42
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||2.35|0.42
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|0.42|2.35|0.42
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||2.35|0.42
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|2.35|0.42
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|0.42|2.35|0.42
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|0.94|2.35|0.42
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||2.35|0.42
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||2.35|0.42
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|0.47|2.35|0.42
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|2.09|2.35|0.42
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|0.44|2.35|0.42
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|0.95|2.35|0.42
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|0.42|2.35|0.42
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|2.35|0.42
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|0.95|2.35|0.42
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|0.42|2.35|0.42
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|2.35|0.42
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|2.01|2.35|0.42
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|2.35|2.35|0.42
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|2.19|2.35|0.42
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|0.95|2.35|0.42
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|0.42|2.35|0.42
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|2.35|0.42
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|2.35|0.42
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||2.35|0.42
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|2.35|0.42
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|2.35|0.42
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|2.35|0.42
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|0.42|2.35|0.42
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|2.09|2.35|0.42
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|0.95|2.35|0.42
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|0.42|2.35|0.42
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|2.09|2.35|0.42
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|0.95|2.35|0.42
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|2.35|0.42
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|0.95|2.35|0.42
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|2.35|0.42
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|2.35|0.42
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|0.6|2.35|0.42
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||2.35|0.42
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||2.35|0.42
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|0.42|2.35|0.42
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||2.35|0.42
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|2.35|0.42
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|0.42|2.35|0.42
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|0.94|2.35|0.42
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||2.35|0.42
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||7.1|1.26
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|1.42|7.1|1.26
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|6.31|7.1|1.26
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|1.33|7.1|1.26
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|2.89|7.1|1.26
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|1.26|7.1|1.26
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|7.1|1.26
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|2.89|7.1|1.26
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|1.26|7.1|1.26
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|7.1|1.26
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|6.08|7.1|1.26
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|7.1|7.1|1.26
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|6.63|7.1|1.26
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|2.89|7.1|1.26
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|1.26|7.1|1.26
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|7.1|1.26
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|7.1|1.26
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||7.1|1.26
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|7.1|1.26
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|7.1|1.26
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|7.1|1.26
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|1.26|7.1|1.26
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|6.31|7.1|1.26
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|2.89|7.1|1.26
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|1.26|7.1|1.26
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|6.31|7.1|1.26
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|2.89|7.1|1.26
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|7.1|1.26
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|2.89|7.1|1.26
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|7.1|1.26
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|7.1|1.26
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|1.81|7.1|1.26
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||7.1|1.26
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||7.1|1.26
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|1.26|7.1|1.26
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||7.1|1.26
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|7.1|1.26
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|1.26|7.1|1.26
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|2.84|7.1|1.26
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||7.1|1.26
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||6.72|1.2
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|1.34|6.72|1.2
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|5.98|6.72|1.2
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|1.25|6.72|1.2
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|2.73|6.72|1.2
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|1.2|6.72|1.2
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|6.72|1.2
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|2.73|6.72|1.2
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|1.2|6.72|1.2
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|6.72|1.2
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|5.75|6.72|1.2
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|6.72|6.72|1.2
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|6.27|6.72|1.2
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|2.73|6.72|1.2
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|1.2|6.72|1.2
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|6.72|1.2
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|6.72|1.2
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||6.72|1.2
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|6.72|1.2
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|6.72|1.2
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|6.72|1.2
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|1.2|6.72|1.2
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|5.98|6.72|1.2
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|2.73|6.72|1.2
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|1.2|6.72|1.2
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|5.98|6.72|1.2
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|2.73|6.72|1.2
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|6.72|1.2
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|2.73|6.72|1.2
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|6.72|1.2
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|6.72|1.2
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|1.72|6.72|1.2
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||6.72|1.2
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||6.72|1.2
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|1.2|6.72|1.2
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||6.72|1.2
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|6.72|1.2
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|1.2|6.72|1.2
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|2.69|6.72|1.2
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||6.72|1.2
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||675|120
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|135|675|120
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|600|675|120
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|126|675|120
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|274.28|675|120
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|120|675|120
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|675|120
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|274.28|675|120
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|120|675|120
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|675|120
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|577.5|675|120
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|675|675|120
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|630|675|120
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|274.28|675|120
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|120|675|120
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|675|120
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|675|120
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||675|120
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|675|120
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|675|120
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|675|120
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|120|675|120
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|600|675|120
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|274.28|675|120
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|120|675|120
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|600|675|120
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|274.28|675|120
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|675|120
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|274.28|675|120
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|675|120
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|675|120
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|172.5|675|120
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||675|120
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||675|120
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|120|675|120
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||675|120
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|675|120
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|120|675|120
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|270|675|120
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||675|120
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|58.05|10.32
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|11.61|58.05|10.32
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|51.6|58.05|10.32
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|10.84|58.05|10.32
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|23.59|58.05|10.32
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|10.32|58.05|10.32
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|58.05|10.32
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|23.59|58.05|10.32
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|10.32|58.05|10.32
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|58.05|10.32
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|49.67|58.05|10.32
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|58.05|58.05|10.32
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|54.18|58.05|10.32
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|23.59|58.05|10.32
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|10.32|58.05|10.32
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|58.05|10.32
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|58.05|10.32
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|58.05|10.32
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|58.05|10.32
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|58.05|10.32
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|58.05|10.32
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|10.32|58.05|10.32
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|51.6|58.05|10.32
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|23.59|58.05|10.32
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|10.32|58.05|10.32
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|51.6|58.05|10.32
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|23.59|58.05|10.32
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|58.05|10.32
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|23.59|58.05|10.32
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|58.05|10.32
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|58.05|10.32
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|14.84|58.05|10.32
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|58.05|10.32
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|58.05|10.32
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|10.32|58.05|10.32
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|58.05|10.32
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|58.05|10.32
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|10.32|58.05|10.32
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|23.22|58.05|10.32
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|58.05|10.32
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AARP [1000]|AARP [100000]|1.03||||1.03||122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1.03||||1.03|0.19|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA [101529]|1.03||||1.03|0.82|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMBETTER [2930]|AMBETTER [293000]|1.03||||1.03|0.17|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.03||||1.03|0.38|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.03||||1.03|0.16|122.5|0.16
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]|1.03||||1.03|0.52|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.03||||1.03|0.38|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.03||||1.03|0.16|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.03||||1.03|0.74|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|1.03||||1.03|0.79|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.03||||1.03|0.93|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.03||||1.03|0.87|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|1.03||||1.03|0.38|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.03||||1.03|0.16|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1.03||||1.03|0.71|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA [1260]|CIGNA PPO [126025]|1.03||||1.03|0.62|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.03||||1.03||122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA [145000]|1.03||||1.03|0.71|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|1.03||||1.03|0.52|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1.03||||1.03|0.71|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.03||||1.03|0.16|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.03||||1.03|0.82|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.03||||1.03|0.38|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.03||||1.03|0.16|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1.03||||1.03|0.82|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1.03||||1.03|0.38|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PHCS [1780]|PHCS MULTIPLAN [178000]|1.03||||1.03|0.71|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.03||||1.03|0.38|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|Self-pay|Self-pay|1.03||||1.03|0.21|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|TML [1980]|TML [198000]|1.03||||1.03|0.71|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1.03||||1.03|0.24|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1.03||||1.03||122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNICARE [2040]|UNICARE [204000]|1.03||||1.03||122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.03||||1.03|0.16|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.03||||1.03||122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WEB TPA [2115]|WEB TPA [211500]|1.03||||1.03|0.71|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1.03||||1.03|0.16|122.5|0.16
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]|1.03||||1.03|0.37|122.5|0.16
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|TML WC [212537]|1.03||||1.03||122.5|0.16
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|122.5|0.16
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|24.5|122.5|0.16
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|108.89|122.5|0.16
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|22.87|122.5|0.16
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|49.78|122.5|0.16
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|21.78|122.5|0.16
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|122.5|0.16
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|49.78|122.5|0.16
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|21.78|122.5|0.16
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|122.5|0.16
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|104.8|122.5|0.16
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|122.5|122.5|0.16
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|111.61|122.5|0.16
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|49.78|122.5|0.16
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|21.78|122.5|0.16
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|122.5|0.16
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|122.5|0.16
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|122.5|0.16
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|122.5|0.16
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|122.5|0.16
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|122.5|0.16
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|21.78|122.5|0.16
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|108.89|122.5|0.16
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|49.78|122.5|0.16
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|21.78|122.5|0.16
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|108.89|122.5|0.16
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|49.78|122.5|0.16
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|122.5|0.16
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|49.78|122.5|0.16
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|122.5|0.16
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|122.5|0.16
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|31.31|122.5|0.16
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|122.5|0.16
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|122.5|0.16
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|21.78|122.5|0.16
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|122.5|0.16
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|122.5|0.16
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|21.78|122.5|0.16
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|49|122.5|0.16
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|122.5|0.16
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|1232.82|219.17
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|246.56|1232.82|219.17
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA [101529]|1369.8||||1369.8|1095.84|1232.82|219.17
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AMBETTER [2930]|AMBETTER [293000]|1369.8||||1369.8|230.13|1232.82|219.17
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|500.94|1232.82|219.17
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|219.17|1232.82|219.17
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|1232.82|219.17
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|500.94|1232.82|219.17
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|219.17|1232.82|219.17
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|1232.82|219.17
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|1054.75|1232.82|219.17
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|1232.82|1232.82|219.17
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|1123.24|1232.82|219.17
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|500.94|1232.82|219.17
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|219.17|1232.82|219.17
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|1232.82|219.17
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|1232.82|219.17
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|1232.82|219.17
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|1232.82|219.17
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|1232.82|219.17
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|1232.82|219.17
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|219.17|1232.82|219.17
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1369.8||||1369.8|1095.84|1232.82|219.17
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|500.94|1232.82|219.17
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|219.17|1232.82|219.17
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|1095.84|1232.82|219.17
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|500.94|1232.82|219.17
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|1232.82|219.17
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|500.94|1232.82|219.17
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|1232.82|219.17
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|1232.82|219.17
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|315.05|1232.82|219.17
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|1232.82|219.17
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|1232.82|219.17
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|219.17|1232.82|219.17
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|1232.82|219.17
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|1232.82|219.17
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|219.17|1232.82|219.17
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|493.13|1232.82|219.17
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|1232.82|219.17
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||10.64|1.89
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|2.13|10.64|1.89
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|9.46|10.64|1.89
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|1.99|10.64|1.89
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|4.32|10.64|1.89
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|1.89|10.64|1.89
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|10.64|1.89
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|4.32|10.64|1.89
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|1.89|10.64|1.89
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|10.64|1.89
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|9.1|10.64|1.89
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|10.64|10.64|1.89
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|9.93|10.64|1.89
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|4.32|10.64|1.89
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|1.89|10.64|1.89
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|10.64|1.89
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|10.64|1.89
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||10.64|1.89
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|10.64|1.89
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|10.64|1.89
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|10.64|1.89
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|1.89|10.64|1.89
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|9.46|10.64|1.89
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|4.32|10.64|1.89
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|1.89|10.64|1.89
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|9.46|10.64|1.89
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|4.32|10.64|1.89
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|10.64|1.89
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|4.32|10.64|1.89
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|10.64|1.89
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|10.64|1.89
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|2.72|10.64|1.89
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||10.64|1.89
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||10.64|1.89
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|1.89|10.64|1.89
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||10.64|1.89
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|10.64|1.89
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|1.89|10.64|1.89
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|4.26|10.64|1.89
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||10.64|1.89
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AARP [1000]|AARP [100000]|11.82||||11.82||10.64|1.89
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|2.13|10.64|1.89
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AETNA [1015]|AETNA [101529]|11.82||||11.82|9.46|10.64|1.89
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AMBETTER [2930]|AMBETTER [293000]|11.82||||11.82|1.99|10.64|1.89
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|4.32|10.64|1.89
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|1.89|10.64|1.89
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|10.64|1.89
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|4.32|10.64|1.89
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|1.89|10.64|1.89
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|10.64|1.89
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|9.1|10.64|1.89
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|10.64|10.64|1.89
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|9.93|10.64|1.89
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|4.32|10.64|1.89
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|1.89|10.64|1.89
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|10.64|1.89
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|10.64|1.89
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||10.64|1.89
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|10.64|1.89
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|10.64|1.89
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|10.64|1.89
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|1.89|10.64|1.89
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|11.82||||11.82|9.46|10.64|1.89
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|4.32|10.64|1.89
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|1.89|10.64|1.89
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|9.46|10.64|1.89
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|4.32|10.64|1.89
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|10.64|1.89
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|4.32|10.64|1.89
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|10.64|1.89
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|10.64|1.89
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|2.72|10.64|1.89
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||10.64|1.89
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UNICARE [2040]|UNICARE [204000]|11.82||||11.82||10.64|1.89
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|1.89|10.64|1.89
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||10.64|1.89
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|10.64|1.89
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|1.89|10.64|1.89
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|4.26|10.64|1.89
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||10.64|1.89
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||10.64|1.89
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|2.13|10.64|1.89
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|9.46|10.64|1.89
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|1.99|10.64|1.89
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|4.32|10.64|1.89
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|1.89|10.64|1.89
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|10.64|1.89
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|4.32|10.64|1.89
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|1.89|10.64|1.89
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|10.64|1.89
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|9.1|10.64|1.89
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|10.64|10.64|1.89
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|9.93|10.64|1.89
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|4.32|10.64|1.89
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|1.89|10.64|1.89
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|10.64|1.89
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|10.64|1.89
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||10.64|1.89
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|10.64|1.89
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|10.64|1.89
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|10.64|1.89
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|1.89|10.64|1.89
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|9.46|10.64|1.89
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|4.32|10.64|1.89
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|1.89|10.64|1.89
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|9.46|10.64|1.89
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|4.32|10.64|1.89
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|10.64|1.89
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|4.32|10.64|1.89
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|10.64|1.89
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|10.64|1.89
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|2.72|10.64|1.89
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||10.64|1.89
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||10.64|1.89
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|1.89|10.64|1.89
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||10.64|1.89
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|10.64|1.89
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|1.89|10.64|1.89
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|4.26|10.64|1.89
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||10.64|1.89
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|AARP [1000]|AARP [100000]|197.1||||197.1||177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|197.1||||197.1|35.48|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|AETNA [1015]|AETNA [101529]|197.1||||197.1|157.68|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|AMBETTER [2930]|AMBETTER [293000]|197.1||||197.1|33.11|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|197.1||||197.1|72.08|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|197.1||||197.1|31.54|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|197.1||||197.1|98.55|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|197.1||||197.1|72.08|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|197.1||||197.1|31.54|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|197.1||||197.1|141.91|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|197.1||||197.1|0|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|197.1||||197.1|177.39|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|197.1||||197.1|0|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|197.1||||197.1|72.08|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|197.1||||197.1|31.54|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|197.1||||197.1|136|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|CIGNA [1260]|CIGNA PPO [126025]|197.1||||197.1|118.26|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|197.1||||197.1||177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|GROUP PENSION ADMIN [1450]|GPA [145000]|197.1||||197.1|136|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|197.1||||197.1|98.55|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|197.1||||197.1|136|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|197.1||||197.1|31.54|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|197.1||||197.1|157.68|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|197.1||||197.1|72.08|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|197.1||||197.1|31.54|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|197.1||||197.1|157.68|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|197.1||||197.1|72.08|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|PHCS [1780]|PHCS MULTIPLAN [178000]|197.1||||197.1|136|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|197.1||||197.1|72.08|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|Self-pay|Self-pay|197.1||||197.1|39.42|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|TML [1980]|TML [198000]|197.1||||197.1|136|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|197.1||||197.1|45.33|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|UMR [2035]|UMR UNITED HEALTHCARE [203502]|197.1||||197.1||177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|UNICARE [2040]|UNICARE [204000]|197.1||||197.1||177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|197.1||||197.1|31.54|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|197.1||||197.1||177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|WEB TPA [2115]|WEB TPA [211500]|197.1||||197.1|136|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|197.1||||197.1|31.54|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|197.1||||197.1|70.96|177.39|21.78
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|WORKER'S COMP [2125]|TML WC [212537]|197.1||||197.1||177.39|21.78
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|177.39|21.78
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|24.5|177.39|21.78
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|108.89|177.39|21.78
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|22.87|177.39|21.78
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|49.78|177.39|21.78
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|21.78|177.39|21.78
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|177.39|21.78
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|49.78|177.39|21.78
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|21.78|177.39|21.78
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|177.39|21.78
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|104.8|177.39|21.78
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|122.5|177.39|21.78
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|111.61|177.39|21.78
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|49.78|177.39|21.78
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|21.78|177.39|21.78
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|177.39|21.78
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|177.39|21.78
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|177.39|21.78
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|177.39|21.78
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|177.39|21.78
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|177.39|21.78
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|21.78|177.39|21.78
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|108.89|177.39|21.78
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|49.78|177.39|21.78
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|21.78|177.39|21.78
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|108.89|177.39|21.78
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|49.78|177.39|21.78
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|177.39|21.78
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|49.78|177.39|21.78
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|177.39|21.78
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|177.39|21.78
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|31.31|177.39|21.78
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|177.39|21.78
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|177.39|21.78
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|21.78|177.39|21.78
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|177.39|21.78
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|177.39|21.78
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|21.78|177.39|21.78
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|49|177.39|21.78
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|177.39|21.78
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|123.53|21.96
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|24.71|123.53|21.96
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|109.8|123.53|21.96
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|23.06|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|105.68|123.53|21.96
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|123.53|123.53|21.96
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|112.55|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|109.8|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|109.8|123.53|21.96
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|50.19|123.53|21.96
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|123.53|21.96
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|50.19|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|31.57|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|49.41|123.53|21.96
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|123.53|21.96
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|123.53|21.96
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|24.71|123.53|21.96
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|109.8|123.53|21.96
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|23.06|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|105.68|123.53|21.96
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|123.53|123.53|21.96
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|112.55|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|109.8|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|109.8|123.53|21.96
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|50.19|123.53|21.96
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|123.53|21.96
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|50.19|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|31.57|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|49.41|123.53|21.96
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|123.53|21.96
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|123.53|21.96
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|24.71|123.53|21.96
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|109.8|123.53|21.96
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|23.06|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|105.68|123.53|21.96
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|123.53|123.53|21.96
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|112.55|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|109.8|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|109.8|123.53|21.96
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|50.19|123.53|21.96
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|123.53|21.96
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|50.19|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|31.57|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|49.41|123.53|21.96
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|123.53|21.96
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|123.53|21.96
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|24.71|123.53|21.96
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|109.8|123.53|21.96
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|23.06|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|105.68|123.53|21.96
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|123.53|123.53|21.96
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|112.55|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|109.8|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|109.8|123.53|21.96
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|50.19|123.53|21.96
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|123.53|21.96
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|50.19|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|31.57|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|49.41|123.53|21.96
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|123.53|21.96
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|123.53|21.96
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|24.71|123.53|21.96
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|109.8|123.53|21.96
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|23.06|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|105.68|123.53|21.96
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|123.53|123.53|21.96
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|112.55|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|109.8|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|109.8|123.53|21.96
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|50.19|123.53|21.96
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|123.53|21.96
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|50.19|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|31.57|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|49.41|123.53|21.96
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|123.53|21.96
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|123.53|21.96
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|24.71|123.53|21.96
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|109.8|123.53|21.96
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|23.06|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|105.68|123.53|21.96
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|123.53|123.53|21.96
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|112.55|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|109.8|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|109.8|123.53|21.96
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|50.19|123.53|21.96
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|123.53|21.96
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|50.19|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|31.57|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|49.41|123.53|21.96
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|123.53|21.96
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|837|148.8
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|167.4|837|148.8
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|744|837|148.8
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|156.24|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|716.1|837|148.8
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|837|837|148.8
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|762.6|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|148.8|837|148.8
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|744|837|148.8
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|340.1|837|148.8
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|837|148.8
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|340.1|837|148.8
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|837|148.8
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|837|148.8
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|213.9|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|837|148.8
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|837|148.8
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|148.8|837|148.8
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|334.8|837|148.8
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|837|148.8
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|123.53|21.96
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|24.71|123.53|21.96
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|109.8|123.53|21.96
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|23.06|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|105.68|123.53|21.96
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|123.53|123.53|21.96
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|112.55|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|109.8|123.53|21.96
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|50.19|123.53|21.96
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|21.96|123.53|21.96
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|109.8|123.53|21.96
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|50.19|123.53|21.96
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|123.53|21.96
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|50.19|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|31.57|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|123.53|21.96
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|123.53|21.96
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|21.96|123.53|21.96
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|49.41|123.53|21.96
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|123.53|21.96
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
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|3142.13|558.6
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|628.43|3142.13|558.6
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|2793|3142.13|558.6
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|586.53|3142.13|558.6
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|1276.75|3142.13|558.6
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|558.6|3142.13|558.6
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|3142.13|558.6
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|1276.75|3142.13|558.6
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|558.6|3142.13|558.6
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|3142.13|558.6
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|2688.26|3142.13|558.6
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|3142.13|3142.13|558.6
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|2862.83|3142.13|558.6
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|1276.75|3142.13|558.6
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|558.6|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|558.6|3142.13|558.6
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|2793|3142.13|558.6
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|1276.75|3142.13|558.6
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|558.6|3142.13|558.6
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|2793|3142.13|558.6
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|1276.75|3142.13|558.6
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|3142.13|558.6
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|1276.75|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|802.99|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|558.6|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|558.6|3142.13|558.6
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|1256.85|3142.13|558.6
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|3142.13|558.6
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|320.63|57
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|64.13|320.63|57
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|285|320.63|57
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|59.85|320.63|57
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|130.28|320.63|57
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|57|320.63|57
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|320.63|57
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|130.28|320.63|57
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|57|320.63|57
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|320.63|57
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|274.31|320.63|57
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|320.63|320.63|57
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|292.13|320.63|57
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|130.28|320.63|57
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|57|320.63|57
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|320.63|57
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|320.63|57
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|320.63|57
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|320.63|57
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|320.63|57
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|320.63|57
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|57|320.63|57
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|285|320.63|57
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|130.28|320.63|57
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|57|320.63|57
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|285|320.63|57
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|130.28|320.63|57
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|320.63|57
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|130.28|320.63|57
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|320.63|57
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|320.63|57
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|81.94|320.63|57
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|320.63|57
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|320.63|57
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|57|320.63|57
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|320.63|57
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|320.63|57
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|57|320.63|57
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|128.25|320.63|57
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|320.63|57
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|3142.13|558.6
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|628.43|3142.13|558.6
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|2793|3142.13|558.6
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|586.53|3142.13|558.6
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|1276.75|3142.13|558.6
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|558.6|3142.13|558.6
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|3142.13|558.6
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|1276.75|3142.13|558.6
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|558.6|3142.13|558.6
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|3142.13|558.6
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|2688.26|3142.13|558.6
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|3142.13|3142.13|558.6
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|2862.83|3142.13|558.6
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|1276.75|3142.13|558.6
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|558.6|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|558.6|3142.13|558.6
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|2793|3142.13|558.6
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|1276.75|3142.13|558.6
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|558.6|3142.13|558.6
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|2793|3142.13|558.6
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|1276.75|3142.13|558.6
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|3142.13|558.6
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|1276.75|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|802.99|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|558.6|3142.13|558.6
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|3142.13|558.6
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|3142.13|558.6
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|558.6|3142.13|558.6
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|1256.85|3142.13|558.6
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|3142.13|558.6
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|2565|456
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|513|2565|456
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|2280|2565|456
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|478.8|2565|456
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|1042.25|2565|456
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|456|2565|456
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|2565|456
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|1042.25|2565|456
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|456|2565|456
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|2565|456
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|2194.5|2565|456
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|2565|2565|456
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|2337|2565|456
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|1042.25|2565|456
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|456|2565|456
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|2565|456
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|2565|456
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|2565|456
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|2565|456
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|2565|456
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|2565|456
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|456|2565|456
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|2280|2565|456
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|1042.25|2565|456
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|456|2565|456
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|2280|2565|456
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|1042.25|2565|456
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|2565|456
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|1042.25|2565|456
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|2565|456
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|2565|456
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|655.5|2565|456
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|2565|456
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|2565|456
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|456|2565|456
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|2565|456
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|2565|456
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|456|2565|456
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|1026|2565|456
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|2565|456
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|AARP [1000]|AARP [100000]|2298.26||||2298.26||2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2298.26||||2298.26|413.69|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|AETNA [1015]|AETNA [101529]|2298.26||||2298.26|2022.47|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|AMBETTER [2930]|AMBETTER [293000]|2298.26||||2298.26|386.11|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2298.26||||2298.26|840.47|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2298.26||||2298.26|367.72|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|ANDREWS CENTER BEHAVIORAL HEALTH [3950]|ANDREWS CENTER BEHAVIORAL HEALTH [395000]|2298.26||||2298.26|1.22|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2298.26||||2298.26|840.47|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2298.26||||2298.26|367.72|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2298.26||||2298.26|0|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|2298.26||||2298.26|0|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2298.26||||2298.26|2068.43|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2298.26||||2298.26|0|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|2298.26||||2298.26|840.47|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2298.26||||2298.26|367.72|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2298.26||||2298.26|1585.8|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|CIGNA [1260]|CIGNA PPO [126025]|2298.26||||2298.26|1378.96|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2298.26||||2298.26||2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA [145000]|2298.26||||2298.26|1585.8|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|2298.26||||2298.26|1.22|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2298.26||||2298.26|1585.8|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2298.26||||2298.26|367.72|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2298.26||||2298.26|2022.47|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2298.26||||2298.26|840.47|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2298.26||||2298.26|367.72|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|2298.26||||2298.26|2022.47|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2298.26||||2298.26|840.47|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|PHCS [1780]|PHCS MULTIPLAN [178000]|2298.26||||2298.26|1585.8|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2298.26||||2298.26|840.47|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|Self-pay|Self-pay|2298.26||||2298.26|459.65|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|TML [1980]|TML [198000]|2298.26||||2298.26|1585.8|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2298.26||||2298.26|528.6|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|UMR [2035]|UMR UNITED HEALTHCARE [203502]|2298.26||||2298.26||2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|UNICARE [2040]|UNICARE [204000]|2298.26||||2298.26||2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2298.26||||2298.26|367.72|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2298.26||||2298.26||2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|WEB TPA [2115]|WEB TPA [211500]|2298.26||||2298.26|1585.8|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|2298.26||||2298.26|367.72|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|TEXAS A&M UNIVERSITY RISK MGT [2125109]|2298.26||||2298.26|827.37|2068.43|1.22
10036|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FILGRASTIM 300 MCG/ML INJECTION SOLUTION|1 mL|WORKER'S COMP [2125]|TML WC [212537]|2298.26||||2298.26||2068.43|1.22
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|2068.43|1.22
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|13.67|2068.43|1.22
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|60.74|2068.43|1.22
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|12.76|2068.43|1.22
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|27.77|2068.43|1.22
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|12.15|2068.43|1.22
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|2068.43|1.22
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|27.77|2068.43|1.22
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|12.15|2068.43|1.22
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|2068.43|1.22
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|58.47|2068.43|1.22
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|68.34|2068.43|1.22
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|62.26|2068.43|1.22
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|27.77|2068.43|1.22
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|12.15|2068.43|1.22
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|2068.43|1.22
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|2068.43|1.22
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|2068.43|1.22
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|2068.43|1.22
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|2068.43|1.22
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|2068.43|1.22
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|12.15|2068.43|1.22
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|60.74|2068.43|1.22
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|27.77|2068.43|1.22
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|12.15|2068.43|1.22
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|60.74|2068.43|1.22
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|27.77|2068.43|1.22
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|2068.43|1.22
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|27.77|2068.43|1.22
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|2068.43|1.22
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|2068.43|1.22
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|17.46|2068.43|1.22
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|2068.43|1.22
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|2068.43|1.22
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|12.15|2068.43|1.22
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|2068.43|1.22
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|2068.43|1.22
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|12.15|2068.43|1.22
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|27.33|2068.43|1.22
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|2068.43|1.22
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AARP [1000]|AARP [100000]|1.32||||1.32||68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1.32||||1.32|0.24|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA [101529]|1.32||||1.32|1.06|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AMBETTER [2930]|AMBETTER [293000]|1.32||||1.32|0.22|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.32||||1.32|0.48|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.32||||1.32|0.21|68.34|0.21
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]|1.32||||1.32|0.66|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.32||||1.32|0.48|68.34|0.21
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]|1.32||||1.32|0.21|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.32||||1.32|0.95|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|1.32||||1.32|1.02|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.32||||1.32|1.19|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.32||||1.32|1.11|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|1.32||||1.32|0.48|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.32||||1.32|0.21|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1.32||||1.32|0.91|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|CIGNA [1260]|CIGNA PPO [126025]|1.32||||1.32|0.79|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.32||||1.32||68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA [145000]|1.32||||1.32|0.91|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|1.32||||1.32|0.66|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1.32||||1.32|0.91|68.34|0.21
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]|1.32||||1.32|0.21|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.32||||1.32|1.06|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.32||||1.32|0.48|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.32||||1.32|0.21|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1.32||||1.32|1.06|68.34|0.21
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]|1.32||||1.32|0.48|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|PHCS [1780]|PHCS MULTIPLAN [178000]|1.32||||1.32|0.91|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.32||||1.32|0.48|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|Self-pay|Self-pay|1.32||||1.32|0.26|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|TML [1980]|TML [198000]|1.32||||1.32|0.91|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1.32||||1.32|0.3|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1.32||||1.32||68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UNICARE [2040]|UNICARE [204000]|1.32||||1.32||68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.32||||1.32|0.21|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.32||||1.32||68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|WEB TPA [2115]|WEB TPA [211500]|1.32||||1.32|0.91|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1.32||||1.32|0.21|68.34|0.21
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]|1.32||||1.32|0.48|68.34|0.21
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|TML WC [212537]|1.32||||1.32||68.34|0.21
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|68.34|0.21
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|13.67|68.34|0.21
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|60.74|68.34|0.21
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|12.76|68.34|0.21
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|27.77|68.34|0.21
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|12.15|68.34|0.21
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|68.34|0.21
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|27.77|68.34|0.21
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|12.15|68.34|0.21
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|68.34|0.21
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|58.47|68.34|0.21
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|68.34|68.34|0.21
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|62.26|68.34|0.21
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|27.77|68.34|0.21
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|12.15|68.34|0.21
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|68.34|0.21
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|68.34|0.21
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|68.34|0.21
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|68.34|0.21
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|68.34|0.21
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|68.34|0.21
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|12.15|68.34|0.21
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|60.74|68.34|0.21
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|27.77|68.34|0.21
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|12.15|68.34|0.21
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|60.74|68.34|0.21
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|27.77|68.34|0.21
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|68.34|0.21
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|27.77|68.34|0.21
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|68.34|0.21
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|68.34|0.21
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|17.46|68.34|0.21
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|68.34|0.21
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|68.34|0.21
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|12.15|68.34|0.21
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|68.34|0.21
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|68.34|0.21
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|12.15|68.34|0.21
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|27.33|68.34|0.21
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|68.34|0.21
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|13.67|68.34|12.15
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|60.74|68.34|12.15
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|12.76|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|58.47|68.34|12.15
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|68.34|68.34|12.15
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|62.26|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|12.15|68.34|12.15
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|60.74|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|27.77|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|17.46|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|68.34|12.15
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|68.34|12.15
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|12.15|68.34|12.15
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|27.33|68.34|12.15
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|68.34|12.15
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AARP [1000]|AARP [100000]|13.66||||13.66||68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.66||||13.66|2.46|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA [101529]|13.66||||13.66|10.93|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AMBETTER [2930]|AMBETTER [293000]|13.66||||13.66|2.29|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|13.66||||13.66|5|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.66||||13.66|2.19|68.34|2.19
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]|13.66||||13.66|6.83|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|13.66||||13.66|5|68.34|2.19
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]|13.66||||13.66|2.19|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|13.66||||13.66|9.84|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|13.66||||13.66|10.52|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|13.66||||13.66|12.29|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|13.66||||13.66|11.47|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CIGNA MEDICAID REPLACEMENT [3945]|CIGNA HEALTHSPRING MEDICAID REPLACEMENT [394500]|13.66||||13.66|5|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.66||||13.66|2.19|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CIGNA [1260]|CIGNA - GREAT WEST [126009]|13.66||||13.66|9.43|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CIGNA [1260]|CIGNA PPO [126025]|13.66||||13.66|8.2|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|13.66||||13.66||68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA [145000]|13.66||||13.66|9.43|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|13.66||||13.66|6.83|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.66||||13.66|9.43|68.34|2.19
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]|13.66||||13.66|2.19|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MAILHANDLERS [1595]|MAILHANDLERS [159500]|13.66||||13.66|10.93|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|13.66||||13.66|5|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.66||||13.66|2.19|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|13.66||||13.66|10.93|68.34|2.19
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]|13.66||||13.66|5|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|PHCS [1780]|PHCS MULTIPLAN [178000]|13.66||||13.66|9.43|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|13.66||||13.66|5|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|Self-pay|Self-pay|13.66||||13.66|2.73|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|TML [1980]|TML [198000]|13.66||||13.66|9.43|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|13.66||||13.66|3.14|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UMR [2035]|UMR UNITED HEALTHCARE [203502]|13.66||||13.66||68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNICARE [2040]|UNICARE [204000]|13.66||||13.66||68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.66||||13.66|2.19|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|13.66||||13.66||68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|WEB TPA [2115]|WEB TPA [211500]|13.66||||13.66|9.43|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|13.66||||13.66|2.19|68.34|2.19
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]|13.66||||13.66|4.92|68.34|2.19
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|TML WC [212537]|13.66||||13.66||68.34|2.19
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|68.34|2.19
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|13.67|68.34|2.19
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|60.74|68.34|2.19
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|12.76|68.34|2.19
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|27.77|68.34|2.19
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|12.15|68.34|2.19
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|68.34|2.19
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|27.77|68.34|2.19
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|12.15|68.34|2.19
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|68.34|2.19
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|58.47|68.34|2.19
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|68.34|68.34|2.19
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|62.26|68.34|2.19
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|27.77|68.34|2.19
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|12.15|68.34|2.19
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|68.34|2.19
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|68.34|2.19
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|68.34|2.19
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|68.34|2.19
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|68.34|2.19
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|68.34|2.19
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|12.15|68.34|2.19
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|60.74|68.34|2.19
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|27.77|68.34|2.19
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|12.15|68.34|2.19
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|60.74|68.34|2.19
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|27.77|68.34|2.19
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|68.34|2.19
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|27.77|68.34|2.19
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|68.34|2.19
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|68.34|2.19
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|17.46|68.34|2.19
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|68.34|2.19
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|68.34|2.19
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|12.15|68.34|2.19
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|68.34|2.19
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|68.34|2.19
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|12.15|68.34|2.19
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|27.33|68.34|2.19
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|68.34|2.19
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|68.85|12.24
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|13.77|68.85|12.24
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|61.2|68.85|12.24
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|12.85|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|58.91|68.85|12.24
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|68.85|68.85|12.24
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|62.73|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|17.6|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|27.54|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|13.77|68.85|12.24
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|61.2|68.85|12.24
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|12.85|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|58.91|68.85|12.24
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|68.85|68.85|12.24
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|62.73|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|17.6|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|27.54|68.85|12.24
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|68.85|12.24
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|413.1|73.44
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|82.62|413.1|73.44
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AETNA [1015]|AETNA [101529]|459||||459|367.2|413.1|73.44
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AMBETTER [2930]|AMBETTER [293000]|459||||459|77.11|413.1|73.44
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|167.86|413.1|73.44
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|73.44|413.1|73.44
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|413.1|73.44
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|167.86|413.1|73.44
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|73.44|413.1|73.44
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|413.1|73.44
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|353.43|413.1|73.44
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|413.1|413.1|73.44
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|385.56|413.1|73.44
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|167.86|413.1|73.44
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|73.44|413.1|73.44
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|413.1|73.44
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|413.1|73.44
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|413.1|73.44
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|413.1|73.44
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|413.1|73.44
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|413.1|73.44
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|73.44|413.1|73.44
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|459||||459|367.2|413.1|73.44
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|167.86|413.1|73.44
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|73.44|413.1|73.44
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|367.2|413.1|73.44
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|167.86|413.1|73.44
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|413.1|73.44
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|167.86|413.1|73.44
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|413.1|73.44
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|413.1|73.44
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|105.57|413.1|73.44
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|413.1|73.44
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|413.1|73.44
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|73.44|413.1|73.44
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|413.1|73.44
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|413.1|73.44
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|73.44|413.1|73.44
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|165.24|413.1|73.44
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|413.1|73.44
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||391.5|69.6
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|78.3|391.5|69.6
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|348|391.5|69.6
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|73.08|391.5|69.6
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|159.08|391.5|69.6
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|69.6|391.5|69.6
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|391.5|69.6
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|159.08|391.5|69.6
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|69.6|391.5|69.6
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|391.5|69.6
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|334.95|391.5|69.6
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|391.5|391.5|69.6
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|365.4|391.5|69.6
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|159.08|391.5|69.6
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|69.6|391.5|69.6
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|391.5|69.6
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|391.5|69.6
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||391.5|69.6
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|391.5|69.6
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|391.5|69.6
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|391.5|69.6
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|69.6|391.5|69.6
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|348|391.5|69.6
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|159.08|391.5|69.6
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|69.6|391.5|69.6
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|348|391.5|69.6
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|159.08|391.5|69.6
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|391.5|69.6
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|159.08|391.5|69.6
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|391.5|69.6
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|391.5|69.6
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|100.05|391.5|69.6
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||391.5|69.6
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||391.5|69.6
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|69.6|391.5|69.6
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||391.5|69.6
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|391.5|69.6
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|69.6|391.5|69.6
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|156.6|391.5|69.6
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||391.5|69.6
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|291.6|51.84
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|58.32|291.6|51.84
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|259.2|291.6|51.84
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|54.43|291.6|51.84
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|118.49|291.6|51.84
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|51.84|291.6|51.84
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|291.6|51.84
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|118.49|291.6|51.84
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|51.84|291.6|51.84
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|291.6|51.84
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|249.48|291.6|51.84
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|291.6|291.6|51.84
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|265.68|291.6|51.84
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|118.49|291.6|51.84
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|51.84|291.6|51.84
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|291.6|51.84
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|291.6|51.84
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|291.6|51.84
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|291.6|51.84
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|291.6|51.84
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|291.6|51.84
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|51.84|291.6|51.84
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|259.2|291.6|51.84
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|118.49|291.6|51.84
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|51.84|291.6|51.84
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|259.2|291.6|51.84
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|118.49|291.6|51.84
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|291.6|51.84
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|118.49|291.6|51.84
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|291.6|51.84
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|291.6|51.84
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|74.52|291.6|51.84
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|291.6|51.84
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|291.6|51.84
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|51.84|291.6|51.84
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|291.6|51.84
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|291.6|51.84
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|51.84|291.6|51.84
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|116.64|291.6|51.84
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|291.6|51.84
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|68.85|12.24
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|13.77|68.85|12.24
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|61.2|68.85|12.24
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|12.85|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|58.91|68.85|12.24
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|68.85|68.85|12.24
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|62.73|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|17.6|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|27.54|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|13.77|68.85|12.24
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|61.2|68.85|12.24
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|12.85|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|58.91|68.85|12.24
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|68.85|68.85|12.24
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|62.73|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|17.6|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|27.54|68.85|12.24
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|68.85|12.24
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|3827.3|680.41
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|765.46|3827.3|680.41
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|3402.05|3827.3|680.41
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|714.43|3827.3|680.41
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|1555.16|3827.3|680.41
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|680.41|3827.3|680.41
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|3827.3|680.41
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|1555.16|3827.3|680.41
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|680.41|3827.3|680.41
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|3827.3|680.41
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|3274.47|3827.3|680.41
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|3827.3|3827.3|680.41
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|3487.1|3827.3|680.41
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|1555.16|3827.3|680.41
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|680.41|3827.3|680.41
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|3827.3|680.41
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|3827.3|680.41
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|3827.3|680.41
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|3827.3|680.41
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|3827.3|680.41
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|3827.3|680.41
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|680.41|3827.3|680.41
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|3402.05|3827.3|680.41
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|1555.16|3827.3|680.41
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|680.41|3827.3|680.41
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|3402.05|3827.3|680.41
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|1555.16|3827.3|680.41
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|3827.3|680.41
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|1555.16|3827.3|680.41
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|3827.3|680.41
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|3827.3|680.41
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|978.09|3827.3|680.41
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|3827.3|680.41
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|3827.3|680.41
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|680.41|3827.3|680.41
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|3827.3|680.41
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|3827.3|680.41
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|680.41|3827.3|680.41
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|1530.92|3827.3|680.41
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|3827.3|680.41
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]|65.7||||65.7|32.85|68.85|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]|65.7||||65.7|11.83|68.85|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]|65.7||||65.7|52.56|68.85|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]|65.7||||65.7|11.04|68.85|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]|65.7||||65.7|24.03|68.85|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]|65.7||||65.7|10.51|68.85|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]|65.7||||65.7|4.32|68.85|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]|65.7||||65.7|24.03|68.85|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]|65.7||||65.7|10.51|68.85|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]|65.7||||65.7|0|68.85|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]|65.7||||65.7|0|68.85|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]|65.7||||65.7|59.13|68.85|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]|65.7||||65.7|0|68.85|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]|65.7||||65.7|24.03|68.85|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]|65.7||||65.7|10.51|68.85|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]|65.7||||65.7|45.33|68.85|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]|65.7||||65.7|39.42|68.85|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]|65.7||||65.7|32.85|68.85|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]|65.7||||65.7|45.33|68.85|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]|65.7||||65.7|4.32|68.85|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]|65.7||||65.7|45.33|68.85|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]|65.7||||65.7|10.51|68.85|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]|65.7||||65.7|52.56|68.85|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]|65.7||||65.7|24.03|68.85|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]|65.7||||65.7|10.51|68.85|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]|65.7||||65.7|52.56|68.85|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]|65.7||||65.7|24.03|68.85|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]|65.7||||65.7|45.33|68.85|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]|65.7||||65.7|24.03|68.85|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|65.7||||65.7|13.14|68.85|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]|65.7||||65.7|45.33|68.85|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]|65.7||||65.7|15.11|68.85|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]|65.7||||65.7|32.85|68.85|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]|65.7||||65.7|32.85|68.85|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]|65.7||||65.7|10.51|68.85|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]|65.7||||65.7|32.85|68.85|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]|65.7||||65.7|45.33|68.85|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]|65.7||||65.7|10.51|68.85|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]|65.7||||65.7|23.65|68.85|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]|65.7||||65.7|32.85|68.85|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|68.85|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|13.77|68.85|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|61.2|68.85|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|12.85|68.85|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|27.98|68.85|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|12.24|68.85|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|68.85|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|27.98|68.85|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|12.24|68.85|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|68.85|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|58.91|68.85|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|68.85|68.85|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|62.73|68.85|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|27.98|68.85|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|12.24|68.85|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|68.85|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|68.85|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|68.85|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|68.85|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|68.85|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|68.85|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|12.24|68.85|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|61.2|68.85|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|27.98|68.85|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|12.24|68.85|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|61.2|68.85|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|27.98|68.85|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|68.85|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|27.98|68.85|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|68.85|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|68.85|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|17.6|68.85|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|68.85|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|68.85|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|12.24|68.85|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|68.85|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|68.85|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|12.24|68.85|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|27.54|68.85|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|68.85|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||25.62|4.56
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|5.12|25.62|4.56
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|AETNA [1015]|AETNA [101529]|28.47||||28.47|22.78|25.62|4.56
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|AMBETTER [2930]|AMBETTER [293000]|28.47||||28.47|4.78|25.62|4.56
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|10.41|25.62|4.56
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|4.56|25.62|4.56
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|25.62|4.56
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|10.41|25.62|4.56
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|4.56|25.62|4.56
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|25.62|4.56
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|21.92|25.62|4.56
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|25.62|25.62|4.56
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|23.91|25.62|4.56
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|10.41|25.62|4.56
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|4.56|25.62|4.56
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|25.62|4.56
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|25.62|4.56
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||25.62|4.56
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|25.62|4.56
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|25.62|4.56
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|25.62|4.56
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|4.56|25.62|4.56
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|MAILHANDLERS [1595]|MAILHANDLERS [159500]|28.47||||28.47|22.78|25.62|4.56
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|10.41|25.62|4.56
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|4.56|25.62|4.56
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|22.78|25.62|4.56
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|10.41|25.62|4.56
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|25.62|4.56
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|10.41|25.62|4.56
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|25.62|4.56
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|25.62|4.56
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|6.55|25.62|4.56
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||25.62|4.56
1005|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL HEAD NECK LATEX FREE|1|UNICARE [2040]|UNICARE [204000]|28.47||||28.47||25.62|4.56
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|4.56|25.62|4.56
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||25.62|4.56
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|25.62|4.56
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|4.56|25.62|4.56
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|10.25|25.62|4.56
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||25.62|4.56
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|68.85|12.24
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|13.77|68.85|12.24
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|61.2|68.85|12.24
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|12.85|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|58.91|68.85|12.24
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|68.85|68.85|12.24
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|62.73|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|17.6|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|27.54|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|13.77|68.85|12.24
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|61.2|68.85|12.24
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|12.85|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|58.91|68.85|12.24
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|68.85|68.85|12.24
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|62.73|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|17.6|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|27.54|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|13.77|68.85|12.24
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|61.2|68.85|12.24
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|12.85|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|58.91|68.85|12.24
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|68.85|68.85|12.24
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|62.73|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|17.6|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|27.54|68.85|12.24
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|68.85|12.24
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]|10080||||10080||9072|1612.8
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]|10080||||10080|1814.4|9072|1612.8
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]|10080||||10080|8870.4|9072|1612.8
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]|10080||||10080|1693.44|9072|1612.8
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]|10080||||10080|3686.26|9072|1612.8
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]|10080||||10080|1612.8|9072|1612.8
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]|10080||||10080|4737.6|9072|1612.8
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]|10080||||10080|3686.26|9072|1612.8
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]|10080||||10080|1612.8|9072|1612.8
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]|10080||||10080|7257.6|9072|1612.8
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]|10080||||10080|7761.6|9072|1612.8
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]|10080||||10080|9072|9072|1612.8
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]|10080||||10080|8265.6|9072|1612.8
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]|10080||||10080|3686.26|9072|1612.8
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]|10080||||10080|1612.8|9072|1612.8
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]|10080||||10080|6955.2|9072|1612.8
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]|10080||||10080|6048|9072|1612.8
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]|10080||||10080||9072|1612.8
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]|10080||||10080|6955.2|9072|1612.8
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]|10080||||10080|4737.6|9072|1612.8
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]|10080||||10080|6955.2|9072|1612.8
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]|10080||||10080|1612.8|9072|1612.8
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]|10080||||10080|8870.4|9072|1612.8
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]|10080||||10080|3686.26|9072|1612.8
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]|10080||||10080|1612.8|9072|1612.8
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]|10080||||10080|8870.4|9072|1612.8
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]|10080||||10080|3686.26|9072|1612.8
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]|10080||||10080|6955.2|9072|1612.8
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]|10080||||10080|3686.26|9072|1612.8
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|10080||||10080|2016|9072|1612.8
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]|10080||||10080|6955.2|9072|1612.8
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]|10080||||10080|2318.4|9072|1612.8
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]|10080||||10080||9072|1612.8
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]|10080||||10080||9072|1612.8
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]|10080||||10080|1612.8|9072|1612.8
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]|10080||||10080||9072|1612.8
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]|10080||||10080|6955.2|9072|1612.8
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]|10080||||10080|1612.8|9072|1612.8
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]|10080||||10080|3628.8|9072|1612.8
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]|10080||||10080||9072|1612.8
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|68.85|12.24
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|13.77|68.85|12.24
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|61.2|68.85|12.24
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|12.85|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|58.91|68.85|12.24
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|68.85|68.85|12.24
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|62.73|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|17.6|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|27.54|68.85|12.24
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|68.85|12.24
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|15711.41|2793.14
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|3142.28|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|2932.8|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|13441.98|15711.41|2793.14
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|15711.41|15711.41|2793.14
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|14314.84|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|4015.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|6284.56|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|3142.28|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|2932.8|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|13441.98|15711.41|2793.14
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|15711.41|15711.41|2793.14
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|14314.84|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|4015.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|6284.56|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|3142.28|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|2932.8|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|13441.98|15711.41|2793.14
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|15711.41|15711.41|2793.14
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|14314.84|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|4015.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|6284.56|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|3142.28|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|2932.8|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|13441.98|15711.41|2793.14
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|15711.41|15711.41|2793.14
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|14314.84|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|4015.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|6284.56|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|3142.28|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|2932.8|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|13441.98|15711.41|2793.14
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|15711.41|15711.41|2793.14
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|14314.84|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|13965.7|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|15711.41|2793.14
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|6384.07|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|4015.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|15711.41|2793.14
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|15711.41|2793.14
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|2793.14|15711.41|2793.14
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|6284.56|15711.41|2793.14
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|15711.41|2793.14
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|20858.18|3708.12
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|4171.64|20858.18|3708.12
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|18540.6|20858.18|3708.12
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|3893.53|20858.18|3708.12
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|8475.37|20858.18|3708.12
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|3708.12|20858.18|3708.12
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|20858.18|3708.12
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|8475.37|20858.18|3708.12
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|3708.12|20858.18|3708.12
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|20858.18|3708.12
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|17845.33|20858.18|3708.12
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|20858.18|20858.18|3708.12
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|19004.12|20858.18|3708.12
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|8475.37|20858.18|3708.12
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|3708.12|20858.18|3708.12
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|20858.18|3708.12
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|20858.18|3708.12
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|20858.18|3708.12
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|20858.18|3708.12
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|20858.18|3708.12
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|20858.18|3708.12
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|3708.12|20858.18|3708.12
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|18540.6|20858.18|3708.12
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|8475.37|20858.18|3708.12
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|3708.12|20858.18|3708.12
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|18540.6|20858.18|3708.12
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|8475.37|20858.18|3708.12
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|20858.18|3708.12
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|8475.37|20858.18|3708.12
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|20858.18|3708.12
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|20858.18|3708.12
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|5330.42|20858.18|3708.12
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|20858.18|3708.12
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|20858.18|3708.12
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|3708.12|20858.18|3708.12
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|20858.18|3708.12
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|20858.18|3708.12
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|3708.12|20858.18|3708.12
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|8343.27|20858.18|3708.12
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|20858.18|3708.12
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|1971|350.4
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|394.2|1971|350.4
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|1752|1971|350.4
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|367.92|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1686.3|1971|350.4
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|1971|1971|350.4
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|1795.8|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|1752|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1752|1971|350.4
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|800.88|1971|350.4
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|1971|350.4
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|800.88|1971|350.4
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|1971|350.4
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|1971|350.4
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|503.7|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|788.4|1971|350.4
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|1971|350.4
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AARP [1000]|AARP [100000]|6.17||||6.17||68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6.17||||6.17|1.11|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AETNA [1015]|AETNA [101529]|6.17||||6.17|4.94|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AMBETTER [2930]|AMBETTER [293000]|6.17||||6.17|1.04|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6.17||||6.17|2.26|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6.17||||6.17|0.99|68.85|0.99
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]|6.17||||6.17|3.09|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|6.17||||6.17|2.26|68.85|0.99
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]|6.17||||6.17|0.99|68.85|0.99
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]|6.17||||6.17|4.44|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS HMO OF TEXAS [115504]|6.17||||6.17|4.75|68.85|0.99
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]|6.17||||6.17|5.55|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|6.17||||6.17|5.18|68.85|0.99
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]|6.17||||6.17|2.26|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6.17||||6.17|0.99|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CIGNA [1260]|CIGNA - GREAT WEST [126009]|6.17||||6.17|4.26|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CIGNA [1260]|CIGNA PPO [126025]|6.17||||6.17|3.7|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|6.17||||6.17||68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA [145000]|6.17||||6.17|4.26|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HEALTHFIRST [2395]|HEALTH FIRST UTHET EMPLOYEE PLAN [239502]|6.17||||6.17|3.09|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6.17||||6.17|4.26|68.85|0.99
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]|6.17||||6.17|0.99|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MAILHANDLERS [1595]|MAILHANDLERS [159500]|6.17||||6.17|4.94|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|6.17||||6.17|2.26|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6.17||||6.17|0.99|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|6.17||||6.17|4.94|68.85|0.99
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]|6.17||||6.17|2.26|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|PHCS [1780]|PHCS MULTIPLAN [178000]|6.17||||6.17|4.26|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|6.17||||6.17|2.26|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|Self-pay|Self-pay|6.17||||6.17|1.23|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|TML [1980]|TML [198000]|6.17||||6.17|4.26|68.85|0.99
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]|6.17||||6.17|1.42|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UMR [2035]|UMR UNITED HEALTHCARE [203502]|6.17||||6.17||68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UNICARE [2040]|UNICARE [204000]|6.17||||6.17||68.85|0.99
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]|6.17||||6.17|0.99|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6.17||||6.17||68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|WEB TPA [2115]|WEB TPA [211500]|6.17||||6.17|4.26|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|6.17||||6.17|0.99|68.85|0.99
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]|6.17||||6.17|2.22|68.85|0.99
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|WORKER'S COMP [2125]|TML WC [212537]|6.17||||6.17||68.85|0.99
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|68.85|0.99
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|13.77|68.85|0.99
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|61.2|68.85|0.99
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|12.85|68.85|0.99
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|27.98|68.85|0.99
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|12.24|68.85|0.99
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|68.85|0.99
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|27.98|68.85|0.99
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|12.24|68.85|0.99
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|68.85|0.99
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|58.91|68.85|0.99
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|68.85|68.85|0.99
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|62.73|68.85|0.99
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|27.98|68.85|0.99
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|12.24|68.85|0.99
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|68.85|0.99
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|68.85|0.99
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|68.85|0.99
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|68.85|0.99
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|68.85|0.99
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|68.85|0.99
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|12.24|68.85|0.99
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|61.2|68.85|0.99
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|27.98|68.85|0.99
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|12.24|68.85|0.99
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|61.2|68.85|0.99
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|27.98|68.85|0.99
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|68.85|0.99
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|27.98|68.85|0.99
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|68.85|0.99
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|68.85|0.99
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|17.6|68.85|0.99
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|68.85|0.99
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|68.85|0.99
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|12.24|68.85|0.99
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|68.85|0.99
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|68.85|0.99
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|12.24|68.85|0.99
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|27.54|68.85|0.99
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|68.85|0.99
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|1971|350.4
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|394.2|1971|350.4
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|1752|1971|350.4
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|367.92|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1686.3|1971|350.4
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|1971|1971|350.4
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|1795.8|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|1752|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1752|1971|350.4
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|800.88|1971|350.4
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|1971|350.4
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|800.88|1971|350.4
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|1971|350.4
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|1971|350.4
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|503.7|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|788.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|394.2|1971|350.4
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|1752|1971|350.4
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|367.92|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1686.3|1971|350.4
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|1971|1971|350.4
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|1795.8|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|1752|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1752|1971|350.4
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|800.88|1971|350.4
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|1971|350.4
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|800.88|1971|350.4
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|1971|350.4
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|1971|350.4
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|503.7|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|788.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|394.2|1971|350.4
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|1752|1971|350.4
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|367.92|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1686.3|1971|350.4
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|1971|1971|350.4
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|1795.8|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|1752|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1752|1971|350.4
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|800.88|1971|350.4
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|1971|350.4
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|800.88|1971|350.4
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|1971|350.4
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|1971|350.4
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|503.7|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|788.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|394.2|1971|350.4
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|1752|1971|350.4
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|367.92|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1686.3|1971|350.4
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|1971|1971|350.4
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|1795.8|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|1752|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1752|1971|350.4
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|800.88|1971|350.4
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|1971|350.4
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|800.88|1971|350.4
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|1971|350.4
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|1971|350.4
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|503.7|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|788.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|394.2|1971|350.4
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|1752|1971|350.4
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|367.92|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1686.3|1971|350.4
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|1971|1971|350.4
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|1795.8|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|1752|1971|350.4
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|800.88|1971|350.4
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|350.4|1971|350.4
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|1752|1971|350.4
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|800.88|1971|350.4
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|1971|350.4
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|800.88|1971|350.4
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|1971|350.4
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|1971|350.4
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|503.7|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|1971|350.4
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|1971|350.4
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|350.4|1971|350.4
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|788.4|1971|350.4
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|1971|350.4
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|68.85|12.24
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|13.77|68.85|12.24
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|61.2|68.85|12.24
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|12.85|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|58.91|68.85|12.24
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|68.85|68.85|12.24
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|62.73|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|17.6|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|27.54|68.85|12.24
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|68.85|12.24
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|6228.9|1107.36
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|1245.78|6228.9|1107.36
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|5536.8|6228.9|1107.36
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|1162.73|6228.9|1107.36
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|2531.01|6228.9|1107.36
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|1107.36|6228.9|1107.36
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|6228.9|1107.36
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|2531.01|6228.9|1107.36
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|1107.36|6228.9|1107.36
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|6228.9|1107.36
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|5329.17|6228.9|1107.36
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|6228.9|6228.9|1107.36
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|5675.22|6228.9|1107.36
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|2531.01|6228.9|1107.36
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|1107.36|6228.9|1107.36
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|6228.9|1107.36
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|6228.9|1107.36
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|6228.9|1107.36
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|6228.9|1107.36
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|6228.9|1107.36
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|6228.9|1107.36
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|1107.36|6228.9|1107.36
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|5536.8|6228.9|1107.36
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|2531.01|6228.9|1107.36
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|1107.36|6228.9|1107.36
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|5536.8|6228.9|1107.36
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|2531.01|6228.9|1107.36
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|6228.9|1107.36
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|2531.01|6228.9|1107.36
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|6228.9|1107.36
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|6228.9|1107.36
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|1591.83|6228.9|1107.36
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|6228.9|1107.36
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|6228.9|1107.36
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|1107.36|6228.9|1107.36
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|6228.9|1107.36
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|6228.9|1107.36
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|1107.36|6228.9|1107.36
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|2491.56|6228.9|1107.36
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|6228.9|1107.36
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|68.85|12.24
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|13.77|68.85|12.24
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|61.2|68.85|12.24
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|12.85|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|58.91|68.85|12.24
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|68.85|68.85|12.24
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|62.73|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|61.2|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|17.6|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|12.24|68.85|12.24
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|27.54|68.85|12.24
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|68.85|12.24
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|68.85|12.24
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|13.77|68.85|12.24
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|61.2|68.85|12.24
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|12.85|68.85|12.24
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|27.98|68.85|12.24
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|12.24|68.85|12.24
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|68.85|12.24
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|27.98|68.85|12.24
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3