"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"
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|2.14||||2.14|1.9|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|2.14||||2.14|0.33|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA LIBERTY [101531]|2.14||||2.14|1.61|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA PPO [101526]|2.14||||2.14|1.9|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2.14||||2.14|1.9|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2.14||||2.14|0.21|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|2.14||||2.14|2.14|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|2.14||||2.14|2.14|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|2.14||||2.14|2.08|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|2.14||||2.14|2.08|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|BCBS [1155]|EMPIRE BCBS PPO [115559]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|2.14||||2.14|1.71|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|2.14||||2.14|1.96|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|CIGNA [1260]|CIGNA INDEMNITY [126019]|2.14||||2.14|1.96|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|2.14||||2.14|0.31|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|GHI [243003]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|2.14||||2.14|0.21|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|2.14||||2.14|1.61|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|GEHA [1415]|GEHA - ASA [141503]|2.14||||2.14|1.9|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|GILSBAR [1425]|GILSBAR [142500]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|2.14||||2.14|0.19|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HEALTHFIRST [2395]|HEALTHFIRST [239500]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|2.14||||2.14|0|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|2.14||||2.14|2.14|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HORIZON [3625]|HORIZON BCBS UNION [362506]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HORIZON [3625]|HORIZON FEDERAL [362504]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HORIZON [3625]|HORIZON PIP AUTO [362505]|2.14||||2.14|1.2|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|2.14||||2.14|1.07|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2.14||||2.14|0.19|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|2.14||||2.14|1.9|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2.14||||2.14|1.9|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MVA [1690]|NJ PLIGA        [169009]|2.14||||2.14|2.14|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|2.14||||2.14|1.96|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2.14||||2.14|1.96|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|2.14||||2.14|1.9|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|2.14||||2.14|1.69|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|QUALCARE [3725]|QUALCARE HMO/POS [372501]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|QUALCARE [3725]|QUALCARE PPO [372503]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|2.14||||2.14|1.96|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|Self-pay|Self-pay|2.14||||2.14|2.14|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|2.14||||2.14|0.21|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2.14||||2.14|0.22|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UMR [2035]|UMR UNITED HEALTHCARE [203502]|2.14||||2.14|0.22|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2.14||||2.14|0|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|2.14||||2.14|0|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|2.14||||2.14|0|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|2.14||||2.14|0|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2.14||||2.14|0|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|WEB TPA [2115]|WEB TPA [211500]|2.14||||2.14|1.82|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|2.14||||2.14||2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2.14||||2.14|2.14|2.14|0.19
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|QUALCARE WC [212530]|2.14||||2.14|1.69|2.14|0.19
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|406.56||||406.56|406.56|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|406.56||||406.56|199.21|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|406.56||||406.56||406.56|35.41
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 LIBERTY [101531]|406.56||||406.56|304.92|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|406.56||||406.56||406.56|35.41
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 PPO [101526]|406.56||||406.56|406.56|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406.56||||406.56|406.56|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406.56||||406.56|345.58|406.56|35.41
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]|406.56||||406.56|39.36|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|406.56||||406.56|243.94|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|406.56||||406.56|243.94|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|406.56||||406.56|219.54|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|406.56||||406.56|219.54|406.56|35.41
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]|BCBS NJ MEDICARE BLUE [116002]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS HMO POS EPO [115558]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS PPO [115559]|406.56||||406.56||406.56|35.41
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 BEHAVIORAL HEALTH [126013]|406.56||||406.56|325.25|406.56|35.41
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 HMO POS OPEN ACCESS [126018]|406.56||||406.56|223.61|406.56|35.41
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 INDEMNITY [126019]|406.56||||406.56|223.61|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|406.56||||406.56|58.95|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|406.56||||406.56|325.25|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMBLEM HEALTH [2430]|GHI [243003]|406.56||||406.56|239.87|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|406.56||||406.56|39.36|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|406.56||||406.56|304.92|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GEHA [1415]|GEHA - ASA [141503]|406.56||||406.56|406.56|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GILSBAR [1425]|GILSBAR [142500]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|406.56||||406.56|35.41|406.56|35.41
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]|HEALTHFIRST [239500]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHNET [1495]|HEALTHNET [149500]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|406.56||||406.56||406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|406.56||||406.56||406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|406.56||||406.56|0|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|406.56||||406.56|406.56|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|406.56||||406.56||406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|406.56||||406.56||406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|406.56||||406.56||406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|406.56||||406.56||406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON FEDERAL [362504]|406.56||||406.56||406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|406.56||||406.56|228.41|406.56|35.41
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]|406.56||||406.56|239.87|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|406.56||||406.56|203.28|406.56|35.41
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]|406.56||||406.56|35.41|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|406.56||||406.56||406.56|35.41
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 ARDENT EMPLOYEE [368502]|406.56||||406.56|406.56|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|406.56||||406.56|406.56|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MULTIPLAN [1680]|IHC HS [168011]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVA [1690]|NJ PLIGA        [169009]|406.56||||406.56|406.56|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|406.56||||406.56|223.61|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|406.56||||406.56|223.61|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|406.56||||406.56|406.56|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|406.56||||406.56||406.56|35.41
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]|GROUP HEALTH COOPERATIVE SCW [178012]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|406.56||||406.56|239.87|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|406.56||||406.56|239.87|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE PPO [372503]|406.56||||406.56|239.87|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|406.56||||406.56|223.61|406.56|35.41
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|406.56||||406.56|406.56|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|STARMARK [203000]|406.56||||406.56|345.58|406.56|35.41
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]|UHCCP [375500]|406.56||||406.56|39.36|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406.56||||406.56|42.69|406.56|35.41
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]|406.56||||406.56|42.69|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|406.56||||406.56|0|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|406.56||||406.56||406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|406.56||||406.56|0|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|406.56||||406.56|0|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56|345.58|406.56|35.41
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|406.56||||406.56|182.95|406.56|35.41
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]|406.56||||406.56|182.95|406.56|35.41
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]|CNA INSURANCE WC [2125100]|406.56||||406.56|406.56|406.56|35.41
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]|QUALCARE WC [212530]|406.56||||406.56|239.87|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|406.56||||406.56|406.56|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|406.56||||406.56|199.21|406.56|35.41
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 NNJ PRIME HMO [102003]|406.56||||406.56||406.56|35.41
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 LIBERTY [101531]|406.56||||406.56|304.92|406.56|35.41
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 MEDICARE SUPPLEMENT [101514]|406.56||||406.56||406.56|35.41
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 PPO [101526]|406.56||||406.56|406.56|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406.56||||406.56|406.56|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406.56||||406.56|345.58|406.56|35.41
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]|406.56||||406.56|39.36|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|406.56||||406.56|243.94|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|406.56||||406.56|243.94|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|406.56||||406.56|219.54|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|406.56||||406.56|219.54|406.56|35.41
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]|BCBS NJ MEDICARE BLUE [116002]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS HMO POS EPO [115558]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS PPO [115559]|406.56||||406.56||406.56|35.41
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 BEHAVIORAL HEALTH [126013]|406.56||||406.56|325.25|406.56|35.41
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 HMO POS OPEN ACCESS [126018]|406.56||||406.56|223.61|406.56|35.41
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 INDEMNITY [126019]|406.56||||406.56|223.61|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|406.56||||406.56|58.95|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|406.56||||406.56|325.25|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMBLEM HEALTH [2430]|GHI [243003]|406.56||||406.56|239.87|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|406.56||||406.56|39.36|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|406.56||||406.56|304.92|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GEHA [1415]|GEHA - ASA [141503]|406.56||||406.56|406.56|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GILSBAR [1425]|GILSBAR [142500]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|406.56||||406.56|35.41|406.56|35.41
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]|HEALTHFIRST [239500]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHNET [1495]|HEALTHNET [149500]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|406.56||||406.56||406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|406.56||||406.56||406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|406.56||||406.56|0|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|406.56||||406.56|406.56|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|406.56||||406.56||406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|406.56||||406.56||406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|406.56||||406.56||406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|406.56||||406.56||406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON FEDERAL [362504]|406.56||||406.56||406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|406.56||||406.56|228.41|406.56|35.41
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]|406.56||||406.56|239.87|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|406.56||||406.56|203.28|406.56|35.41
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]|406.56||||406.56|35.41|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|406.56||||406.56||406.56|35.41
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 ARDENT EMPLOYEE [368502]|406.56||||406.56|406.56|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|406.56||||406.56|406.56|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MULTIPLAN [1680]|IHC HS [168011]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVA [1690]|NJ PLIGA        [169009]|406.56||||406.56|406.56|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|406.56||||406.56|223.61|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|406.56||||406.56|223.61|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|406.56||||406.56|406.56|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|406.56||||406.56||406.56|35.41
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]|GROUP HEALTH COOPERATIVE SCW [178012]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|406.56||||406.56|239.87|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|406.56||||406.56|239.87|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE PPO [372503]|406.56||||406.56|239.87|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|406.56||||406.56|223.61|406.56|35.41
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|406.56||||406.56|406.56|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|STARMARK [203000]|406.56||||406.56|345.58|406.56|35.41
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]|UHCCP [375500]|406.56||||406.56|39.36|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406.56||||406.56|42.69|406.56|35.41
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]|406.56||||406.56|42.69|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|406.56||||406.56|0|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|406.56||||406.56||406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56||406.56|35.41
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 - BIND [206032]|406.56||||406.56|0|406.56|35.41
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]|UNITED HEALTHCARE OXFORD [206009]|406.56||||406.56|0|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56|345.58|406.56|35.41
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|406.56||||406.56|182.95|406.56|35.41
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]|406.56||||406.56|182.95|406.56|35.41
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]|CNA INSURANCE WC [2125100]|406.56||||406.56|406.56|406.56|35.41
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]|QUALCARE WC [212530]|406.56||||406.56|239.87|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|406.56||||406.56|406.56|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|406.56||||406.56|199.21|406.56|35.41
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 NNJ PRIME HMO [102003]|406.56||||406.56||406.56|35.41
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 LIBERTY [101531]|406.56||||406.56|304.92|406.56|35.41
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 MEDICARE SUPPLEMENT [101514]|406.56||||406.56||406.56|35.41
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 PPO [101526]|406.56||||406.56|406.56|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406.56||||406.56|406.56|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406.56||||406.56|345.58|406.56|35.41
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]|406.56||||406.56|39.36|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|406.56||||406.56|243.94|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|406.56||||406.56|243.94|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|406.56||||406.56|219.54|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|406.56||||406.56|219.54|406.56|35.41
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]|BCBS NJ MEDICARE BLUE [116002]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS HMO POS EPO [115558]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS PPO [115559]|406.56||||406.56||406.56|35.41
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 BEHAVIORAL HEALTH [126013]|406.56||||406.56|325.25|406.56|35.41
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 HMO POS OPEN ACCESS [126018]|406.56||||406.56|223.61|406.56|35.41
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 INDEMNITY [126019]|406.56||||406.56|223.61|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|406.56||||406.56|58.95|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|406.56||||406.56|325.25|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMBLEM HEALTH [2430]|GHI [243003]|406.56||||406.56|239.87|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|406.56||||406.56|39.36|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|406.56||||406.56|304.92|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GEHA [1415]|GEHA - ASA [141503]|406.56||||406.56|406.56|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GILSBAR [1425]|GILSBAR [142500]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|406.56||||406.56|35.41|406.56|35.41
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]|HEALTHFIRST [239500]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHNET [1495]|HEALTHNET [149500]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|406.56||||406.56||406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|406.56||||406.56||406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|406.56||||406.56|0|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|406.56||||406.56|406.56|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|406.56||||406.56||406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|406.56||||406.56||406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|406.56||||406.56||406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|406.56||||406.56||406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON FEDERAL [362504]|406.56||||406.56||406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|406.56||||406.56|228.41|406.56|35.41
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]|406.56||||406.56|239.87|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|406.56||||406.56|203.28|406.56|35.41
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]|406.56||||406.56|35.41|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|406.56||||406.56||406.56|35.41
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 ARDENT EMPLOYEE [368502]|406.56||||406.56|406.56|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|406.56||||406.56|406.56|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MULTIPLAN [1680]|IHC HS [168011]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVA [1690]|NJ PLIGA        [169009]|406.56||||406.56|406.56|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|406.56||||406.56|223.61|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|406.56||||406.56|223.61|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|406.56||||406.56|406.56|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|406.56||||406.56||406.56|35.41
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]|GROUP HEALTH COOPERATIVE SCW [178012]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|406.56||||406.56|239.87|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|406.56||||406.56|239.87|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE PPO [372503]|406.56||||406.56|239.87|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|406.56||||406.56|223.61|406.56|35.41
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|406.56||||406.56|406.56|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|STARMARK [203000]|406.56||||406.56|345.58|406.56|35.41
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]|UHCCP [375500]|406.56||||406.56|39.36|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406.56||||406.56|42.69|406.56|35.41
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]|406.56||||406.56|42.69|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|406.56||||406.56|0|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|406.56||||406.56||406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56||406.56|35.41
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 - BIND [206032]|406.56||||406.56|0|406.56|35.41
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]|UNITED HEALTHCARE OXFORD [206009]|406.56||||406.56|0|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56|345.58|406.56|35.41
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|406.56||||406.56|182.95|406.56|35.41
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]|406.56||||406.56|182.95|406.56|35.41
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]|CNA INSURANCE WC [2125100]|406.56||||406.56|406.56|406.56|35.41
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]|QUALCARE WC [212530]|406.56||||406.56|239.87|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|406.56||||406.56|406.56|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|406.56||||406.56|199.21|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|406.56||||406.56||406.56|35.41
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 LIBERTY [101531]|406.56||||406.56|304.92|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|406.56||||406.56||406.56|35.41
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 PPO [101526]|406.56||||406.56|406.56|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406.56||||406.56|406.56|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406.56||||406.56|345.58|406.56|35.41
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]|406.56||||406.56|39.36|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|406.56||||406.56|243.94|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|406.56||||406.56|243.94|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|406.56||||406.56|219.54|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|406.56||||406.56|219.54|406.56|35.41
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]|BCBS NJ MEDICARE BLUE [116002]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS HMO POS EPO [115558]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS PPO [115559]|406.56||||406.56||406.56|35.41
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 BEHAVIORAL HEALTH [126013]|406.56||||406.56|325.25|406.56|35.41
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 HMO POS OPEN ACCESS [126018]|406.56||||406.56|223.61|406.56|35.41
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 INDEMNITY [126019]|406.56||||406.56|223.61|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|406.56||||406.56|58.95|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|406.56||||406.56|325.25|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMBLEM HEALTH [2430]|GHI [243003]|406.56||||406.56|239.87|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|406.56||||406.56|39.36|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|406.56||||406.56|304.92|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GEHA [1415]|GEHA - ASA [141503]|406.56||||406.56|406.56|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GILSBAR [1425]|GILSBAR [142500]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|406.56||||406.56|35.41|406.56|35.41
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]|HEALTHFIRST [239500]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHNET [1495]|HEALTHNET [149500]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|406.56||||406.56||406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|406.56||||406.56||406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|406.56||||406.56|0|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|406.56||||406.56|406.56|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|406.56||||406.56||406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|406.56||||406.56||406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|406.56||||406.56||406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|406.56||||406.56||406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON FEDERAL [362504]|406.56||||406.56||406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|406.56||||406.56|228.41|406.56|35.41
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]|406.56||||406.56|239.87|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|406.56||||406.56|203.28|406.56|35.41
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]|406.56||||406.56|35.41|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|406.56||||406.56||406.56|35.41
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 ARDENT EMPLOYEE [368502]|406.56||||406.56|406.56|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|406.56||||406.56|406.56|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MULTIPLAN [1680]|IHC HS [168011]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVA [1690]|NJ PLIGA        [169009]|406.56||||406.56|406.56|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|406.56||||406.56|223.61|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|406.56||||406.56|223.61|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|406.56||||406.56|406.56|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|406.56||||406.56||406.56|35.41
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]|GROUP HEALTH COOPERATIVE SCW [178012]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|406.56||||406.56|239.87|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|406.56||||406.56|239.87|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE PPO [372503]|406.56||||406.56|239.87|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|406.56||||406.56|223.61|406.56|35.41
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|406.56||||406.56|406.56|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|STARMARK [203000]|406.56||||406.56|345.58|406.56|35.41
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]|UHCCP [375500]|406.56||||406.56|39.36|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406.56||||406.56|42.69|406.56|35.41
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]|406.56||||406.56|42.69|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|406.56||||406.56|0|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|406.56||||406.56||406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|406.56||||406.56|0|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|406.56||||406.56|0|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56|345.58|406.56|35.41
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|406.56||||406.56|182.95|406.56|35.41
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]|406.56||||406.56|182.95|406.56|35.41
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]|CNA INSURANCE WC [2125100]|406.56||||406.56|406.56|406.56|35.41
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]|QUALCARE WC [212530]|406.56||||406.56|239.87|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|406.56||||406.56|406.56|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|406.56||||406.56|199.21|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|406.56||||406.56||406.56|35.41
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 LIBERTY [101531]|406.56||||406.56|304.92|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|406.56||||406.56||406.56|35.41
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 PPO [101526]|406.56||||406.56|406.56|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406.56||||406.56|406.56|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406.56||||406.56|345.58|406.56|35.41
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]|406.56||||406.56|39.36|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|406.56||||406.56|243.94|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|406.56||||406.56|243.94|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|406.56||||406.56|219.54|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|406.56||||406.56|219.54|406.56|35.41
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]|BCBS NJ MEDICARE BLUE [116002]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS HMO POS EPO [115558]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS PPO [115559]|406.56||||406.56||406.56|35.41
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 BEHAVIORAL HEALTH [126013]|406.56||||406.56|325.25|406.56|35.41
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 HMO POS OPEN ACCESS [126018]|406.56||||406.56|223.61|406.56|35.41
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 INDEMNITY [126019]|406.56||||406.56|223.61|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|406.56||||406.56|58.95|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|406.56||||406.56|325.25|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMBLEM HEALTH [2430]|GHI [243003]|406.56||||406.56|239.87|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|406.56||||406.56|39.36|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|406.56||||406.56|304.92|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GEHA [1415]|GEHA - ASA [141503]|406.56||||406.56|406.56|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GILSBAR [1425]|GILSBAR [142500]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|406.56||||406.56|35.41|406.56|35.41
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]|HEALTHFIRST [239500]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHNET [1495]|HEALTHNET [149500]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|406.56||||406.56||406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|406.56||||406.56||406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|406.56||||406.56|0|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|406.56||||406.56|406.56|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|406.56||||406.56||406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|406.56||||406.56||406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|406.56||||406.56||406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|406.56||||406.56||406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON FEDERAL [362504]|406.56||||406.56||406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|406.56||||406.56|228.41|406.56|35.41
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]|406.56||||406.56|239.87|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|406.56||||406.56|203.28|406.56|35.41
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]|406.56||||406.56|35.41|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|406.56||||406.56||406.56|35.41
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 ARDENT EMPLOYEE [368502]|406.56||||406.56|406.56|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|406.56||||406.56|406.56|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MULTIPLAN [1680]|IHC HS [168011]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVA [1690]|NJ PLIGA        [169009]|406.56||||406.56|406.56|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|406.56||||406.56|223.61|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|406.56||||406.56|223.61|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|406.56||||406.56|406.56|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|406.56||||406.56||406.56|35.41
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]|GROUP HEALTH COOPERATIVE SCW [178012]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|406.56||||406.56|239.87|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|406.56||||406.56|239.87|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE PPO [372503]|406.56||||406.56|239.87|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|406.56||||406.56|223.61|406.56|35.41
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|406.56||||406.56|406.56|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|STARMARK [203000]|406.56||||406.56|345.58|406.56|35.41
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]|UHCCP [375500]|406.56||||406.56|39.36|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406.56||||406.56|42.69|406.56|35.41
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]|406.56||||406.56|42.69|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|406.56||||406.56|0|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|406.56||||406.56||406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|406.56||||406.56|0|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|406.56||||406.56|0|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56|345.58|406.56|35.41
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|406.56||||406.56|182.95|406.56|35.41
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]|406.56||||406.56|182.95|406.56|35.41
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]|CNA INSURANCE WC [2125100]|406.56||||406.56|406.56|406.56|35.41
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]|QUALCARE WC [212530]|406.56||||406.56|239.87|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|406.56||||406.56|406.56|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|406.56||||406.56|199.21|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|406.56||||406.56||406.56|35.41
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 LIBERTY [101531]|406.56||||406.56|304.92|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|406.56||||406.56||406.56|35.41
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 PPO [101526]|406.56||||406.56|406.56|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406.56||||406.56|406.56|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406.56||||406.56|345.58|406.56|35.41
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]|406.56||||406.56|39.36|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|406.56||||406.56|243.94|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|406.56||||406.56|243.94|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|406.56||||406.56|219.54|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|406.56||||406.56|219.54|406.56|35.41
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]|BCBS NJ MEDICARE BLUE [116002]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS HMO POS EPO [115558]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS PPO [115559]|406.56||||406.56||406.56|35.41
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 BEHAVIORAL HEALTH [126013]|406.56||||406.56|325.25|406.56|35.41
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 HMO POS OPEN ACCESS [126018]|406.56||||406.56|223.61|406.56|35.41
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 INDEMNITY [126019]|406.56||||406.56|223.61|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|406.56||||406.56|58.95|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|406.56||||406.56|325.25|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMBLEM HEALTH [2430]|GHI [243003]|406.56||||406.56|239.87|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|406.56||||406.56|39.36|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|406.56||||406.56|304.92|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GEHA [1415]|GEHA - ASA [141503]|406.56||||406.56|406.56|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GILSBAR [1425]|GILSBAR [142500]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|406.56||||406.56|35.41|406.56|35.41
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]|HEALTHFIRST [239500]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHNET [1495]|HEALTHNET [149500]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|406.56||||406.56||406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|406.56||||406.56||406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|406.56||||406.56|0|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|406.56||||406.56|406.56|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|406.56||||406.56||406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|406.56||||406.56||406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|406.56||||406.56||406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|406.56||||406.56||406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON FEDERAL [362504]|406.56||||406.56||406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|406.56||||406.56|228.41|406.56|35.41
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]|406.56||||406.56|239.87|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|406.56||||406.56|203.28|406.56|35.41
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]|406.56||||406.56|35.41|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|406.56||||406.56||406.56|35.41
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 ARDENT EMPLOYEE [368502]|406.56||||406.56|406.56|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|406.56||||406.56|406.56|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MULTIPLAN [1680]|IHC HS [168011]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVA [1690]|NJ PLIGA        [169009]|406.56||||406.56|406.56|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|406.56||||406.56|223.61|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|406.56||||406.56|223.61|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|406.56||||406.56|406.56|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|406.56||||406.56||406.56|35.41
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]|GROUP HEALTH COOPERATIVE SCW [178012]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|406.56||||406.56|239.87|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|406.56||||406.56|239.87|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE PPO [372503]|406.56||||406.56|239.87|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|406.56||||406.56|223.61|406.56|35.41
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|406.56||||406.56|406.56|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|STARMARK [203000]|406.56||||406.56|345.58|406.56|35.41
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]|UHCCP [375500]|406.56||||406.56|39.36|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406.56||||406.56|42.69|406.56|35.41
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]|406.56||||406.56|42.69|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|406.56||||406.56|0|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|406.56||||406.56||406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|406.56||||406.56|0|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|406.56||||406.56|0|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56|345.58|406.56|35.41
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|406.56||||406.56|182.95|406.56|35.41
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]|406.56||||406.56|182.95|406.56|35.41
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]|CNA INSURANCE WC [2125100]|406.56||||406.56|406.56|406.56|35.41
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]|QUALCARE WC [212530]|406.56||||406.56|239.87|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|406.56||||406.56|406.56|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|406.56||||406.56|199.21|406.56|35.41
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 NNJ PRIME HMO [102003]|406.56||||406.56||406.56|35.41
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 LIBERTY [101531]|406.56||||406.56|304.92|406.56|35.41
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 MEDICARE SUPPLEMENT [101514]|406.56||||406.56||406.56|35.41
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 PPO [101526]|406.56||||406.56|406.56|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406.56||||406.56|406.56|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406.56||||406.56|345.58|406.56|35.41
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]|406.56||||406.56|39.36|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|406.56||||406.56|243.94|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|406.56||||406.56|243.94|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|406.56||||406.56|219.54|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|406.56||||406.56|219.54|406.56|35.41
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]|BCBS NJ MEDICARE BLUE [116002]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS HMO POS EPO [115558]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS PPO [115559]|406.56||||406.56||406.56|35.41
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 BEHAVIORAL HEALTH [126013]|406.56||||406.56|325.25|406.56|35.41
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 HMO POS OPEN ACCESS [126018]|406.56||||406.56|223.61|406.56|35.41
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 INDEMNITY [126019]|406.56||||406.56|223.61|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|406.56||||406.56|58.95|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|406.56||||406.56|325.25|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMBLEM HEALTH [2430]|GHI [243003]|406.56||||406.56|239.87|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|406.56||||406.56|39.36|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|406.56||||406.56|304.92|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GEHA [1415]|GEHA - ASA [141503]|406.56||||406.56|406.56|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GILSBAR [1425]|GILSBAR [142500]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|406.56||||406.56|35.41|406.56|35.41
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]|HEALTHFIRST [239500]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHNET [1495]|HEALTHNET [149500]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|406.56||||406.56||406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|406.56||||406.56||406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|406.56||||406.56|0|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|406.56||||406.56|406.56|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|406.56||||406.56||406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|406.56||||406.56||406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|406.56||||406.56||406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|406.56||||406.56||406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON FEDERAL [362504]|406.56||||406.56||406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|406.56||||406.56|228.41|406.56|35.41
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]|406.56||||406.56|239.87|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|406.56||||406.56|203.28|406.56|35.41
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]|406.56||||406.56|35.41|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|406.56||||406.56||406.56|35.41
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 ARDENT EMPLOYEE [368502]|406.56||||406.56|406.56|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|406.56||||406.56|406.56|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MULTIPLAN [1680]|IHC HS [168011]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVA [1690]|NJ PLIGA        [169009]|406.56||||406.56|406.56|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|406.56||||406.56|223.61|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|406.56||||406.56|223.61|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|406.56||||406.56|406.56|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|406.56||||406.56||406.56|35.41
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]|GROUP HEALTH COOPERATIVE SCW [178012]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|406.56||||406.56|239.87|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|406.56||||406.56|239.87|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE PPO [372503]|406.56||||406.56|239.87|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|406.56||||406.56|223.61|406.56|35.41
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|406.56||||406.56|406.56|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|STARMARK [203000]|406.56||||406.56|345.58|406.56|35.41
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]|UHCCP [375500]|406.56||||406.56|39.36|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406.56||||406.56|42.69|406.56|35.41
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]|406.56||||406.56|42.69|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|406.56||||406.56|0|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|406.56||||406.56||406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56||406.56|35.41
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 - BIND [206032]|406.56||||406.56|0|406.56|35.41
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]|UNITED HEALTHCARE OXFORD [206009]|406.56||||406.56|0|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56|345.58|406.56|35.41
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|406.56||||406.56|182.95|406.56|35.41
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]|406.56||||406.56|182.95|406.56|35.41
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]|CNA INSURANCE WC [2125100]|406.56||||406.56|406.56|406.56|35.41
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]|QUALCARE WC [212530]|406.56||||406.56|239.87|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|406.56||||406.56|406.56|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|406.56||||406.56|199.21|406.56|35.41
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 NNJ PRIME HMO [102003]|406.56||||406.56||406.56|35.41
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 LIBERTY [101531]|406.56||||406.56|304.92|406.56|35.41
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 MEDICARE SUPPLEMENT [101514]|406.56||||406.56||406.56|35.41
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 PPO [101526]|406.56||||406.56|406.56|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406.56||||406.56|406.56|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406.56||||406.56|345.58|406.56|35.41
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]|406.56||||406.56|39.36|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|406.56||||406.56|243.94|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|406.56||||406.56|243.94|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|406.56||||406.56|219.54|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|406.56||||406.56|219.54|406.56|35.41
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]|BCBS NJ MEDICARE BLUE [116002]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS HMO POS EPO [115558]|406.56||||406.56||406.56|35.41
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]|EMPIRE BCBS PPO [115559]|406.56||||406.56||406.56|35.41
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 BEHAVIORAL HEALTH [126013]|406.56||||406.56|325.25|406.56|35.41
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 HMO POS OPEN ACCESS [126018]|406.56||||406.56|223.61|406.56|35.41
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 INDEMNITY [126019]|406.56||||406.56|223.61|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|406.56||||406.56|58.95|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|406.56||||406.56|325.25|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMBLEM HEALTH [2430]|GHI [243003]|406.56||||406.56|239.87|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|406.56||||406.56|39.36|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|406.56||||406.56|304.92|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GEHA [1415]|GEHA - ASA [141503]|406.56||||406.56|406.56|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GILSBAR [1425]|GILSBAR [142500]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|406.56||||406.56|35.41|406.56|35.41
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]|HEALTHFIRST [239500]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHNET [1495]|HEALTHNET [149500]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|406.56||||406.56||406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|406.56||||406.56||406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|406.56||||406.56|0|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|406.56||||406.56|406.56|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|406.56||||406.56||406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|406.56||||406.56||406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|406.56||||406.56||406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|406.56||||406.56||406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON FEDERAL [362504]|406.56||||406.56||406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|406.56||||406.56|228.41|406.56|35.41
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]|406.56||||406.56|239.87|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|406.56||||406.56|203.28|406.56|35.41
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]|406.56||||406.56|35.41|406.56|35.41
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]|406.56||||406.56||406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|406.56||||406.56||406.56|35.41
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 ARDENT EMPLOYEE [368502]|406.56||||406.56|406.56|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|406.56||||406.56|406.56|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MULTIPLAN [1680]|IHC HS [168011]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVA [1690]|NJ PLIGA        [169009]|406.56||||406.56|406.56|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|406.56||||406.56|223.61|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|406.56||||406.56|223.61|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|406.56||||406.56|406.56|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|406.56||||406.56||406.56|35.41
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]|GROUP HEALTH COOPERATIVE SCW [178012]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|406.56||||406.56|239.87|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|406.56||||406.56|239.87|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE PPO [372503]|406.56||||406.56|239.87|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|406.56||||406.56|223.61|406.56|35.41
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|406.56||||406.56|406.56|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|STARMARK [203000]|406.56||||406.56|345.58|406.56|35.41
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]|UHCCP [375500]|406.56||||406.56|39.36|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406.56||||406.56|42.69|406.56|35.41
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]|406.56||||406.56|42.69|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|406.56||||406.56|0|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|406.56||||406.56||406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56||406.56|35.41
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 - BIND [206032]|406.56||||406.56|0|406.56|35.41
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]|UNITED HEALTHCARE OXFORD [206009]|406.56||||406.56|0|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|406.56||||406.56|0|406.56|35.41
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]|406.56||||406.56|345.58|406.56|35.41
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|406.56||||406.56|182.95|406.56|35.41
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]|406.56||||406.56|182.95|406.56|35.41
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]|CNA INSURANCE WC [2125100]|406.56||||406.56|406.56|406.56|35.41
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]|QUALCARE WC [212530]|406.56||||406.56|239.87|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|406.56||||406.56|406.56|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|406.56||||406.56|199.21|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA LIBERTY [101531]|406.56||||406.56|304.92|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA PPO [101526]|406.56||||406.56|406.56|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406.56||||406.56|406.56|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|406.56||||406.56|39.36|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|406.56||||406.56|243.94|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|406.56||||406.56|243.94|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|406.56||||406.56|219.54|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|406.56||||406.56|219.54|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|406.56||||406.56|325.25|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|406.56||||406.56|223.61|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|406.56||||406.56|223.61|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|406.56||||406.56|58.95|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|406.56||||406.56|325.25|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMBLEM HEALTH [2430]|GHI [243003]|406.56||||406.56|239.87|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|406.56||||406.56|39.36|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|406.56||||406.56|304.92|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GEHA [1415]|GEHA - ASA [141503]|406.56||||406.56|406.56|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GILSBAR [1425]|GILSBAR [142500]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|406.56||||406.56|35.41|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHNET [1495]|HEALTHNET [149500]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|406.56||||406.56|0|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|406.56||||406.56|406.56|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON FEDERAL [362504]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|406.56||||406.56|228.41|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|406.56||||406.56|239.87|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|406.56||||406.56|203.28|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|406.56||||406.56|35.41|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|406.56||||406.56|406.56|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|406.56||||406.56|406.56|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MULTIPLAN [1680]|IHC HS [168011]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVA [1690]|NJ PLIGA        [169009]|406.56||||406.56|406.56|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|406.56||||406.56|223.61|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|406.56||||406.56|223.61|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|406.56||||406.56|406.56|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|406.56||||406.56|239.87|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|406.56||||406.56|239.87|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE PPO [372503]|406.56||||406.56|239.87|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|406.56||||406.56|223.61|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|Self-pay|Self-pay|406.56||||406.56|406.56|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|STARMARK [203000]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|406.56||||406.56|39.36|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406.56||||406.56|42.69|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|406.56||||406.56|42.69|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|406.56||||406.56|0|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|406.56||||406.56|0|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|406.56||||406.56||406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|406.56||||406.56|0|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|406.56||||406.56|0|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|406.56||||406.56|0|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WEB TPA [2115]|WEB TPA [211500]|406.56||||406.56|345.58|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|406.56||||406.56|182.95|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|406.56||||406.56|182.95|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|406.56||||406.56|406.56|406.56|35.41
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|406.56||||406.56|239.87|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|406.56||||406.56|406.56|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|406.56||||406.56|199.21|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA LIBERTY [101531]|406.56||||406.56|304.92|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA [1015]|AETNA PPO [101526]|406.56||||406.56|406.56|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406.56||||406.56|406.56|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|406.56||||406.56|39.36|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|406.56||||406.56|243.94|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|406.56||||406.56|243.94|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|406.56||||406.56|219.54|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|406.56||||406.56|219.54|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|406.56||||406.56|325.25|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|406.56||||406.56|223.61|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|406.56||||406.56|223.61|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|406.56||||406.56|58.95|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|406.56||||406.56|325.25|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMBLEM HEALTH [2430]|GHI [243003]|406.56||||406.56|239.87|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|406.56||||406.56|39.36|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|406.56||||406.56|304.92|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GEHA [1415]|GEHA - ASA [141503]|406.56||||406.56|406.56|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GILSBAR [1425]|GILSBAR [142500]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|406.56||||406.56|35.41|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHNET [1495]|HEALTHNET [149500]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|406.56||||406.56|0|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|406.56||||406.56|406.56|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON FEDERAL [362504]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|406.56||||406.56|228.41|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|406.56||||406.56|239.87|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|406.56||||406.56|203.28|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|406.56||||406.56|35.41|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|406.56||||406.56|406.56|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|406.56||||406.56|406.56|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MULTIPLAN [1680]|IHC HS [168011]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVA [1690]|NJ PLIGA        [169009]|406.56||||406.56|406.56|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|406.56||||406.56|223.61|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|406.56||||406.56|223.61|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|406.56||||406.56|406.56|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|406.56||||406.56|239.87|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|406.56||||406.56|239.87|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|QUALCARE [3725]|QUALCARE PPO [372503]|406.56||||406.56|239.87|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|406.56||||406.56|223.61|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|Self-pay|Self-pay|406.56||||406.56|406.56|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUSTMARK [2030]|STARMARK [203000]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|406.56||||406.56|39.36|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406.56||||406.56|42.69|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|406.56||||406.56|42.69|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|406.56||||406.56|0|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|406.56||||406.56|0|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|406.56||||406.56||406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|406.56||||406.56|0|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|406.56||||406.56|0|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|406.56||||406.56|0|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WEB TPA [2115]|WEB TPA [211500]|406.56||||406.56|345.58|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|406.56||||406.56|182.95|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|406.56||||406.56|182.95|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|406.56||||406.56|406.56|406.56|35.41
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|406.56||||406.56|239.87|406.56|35.41
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|4412.5||||4412.5|1765|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|4412.5||||4412.5|2162.13|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|AETNA [1015]|AETNA LIBERTY [101531]|4412.5||||4412.5|1500.25|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|AETNA [1015]|AETNA PPO [101526]|4412.5||||4412.5|1765|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4412.5||||4412.5|1765|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|4412.5||||4412.5|427.13|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|4412.5||||4412.5|2647.5|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|4412.5||||4412.5|2647.5|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|4412.5||||4412.5|2382.75|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|4412.5||||4412.5|2382.75|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|4412.5||||4412.5|3530|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|4412.5||||4412.5|2426.88|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|4412.5||||4412.5|2426.88|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|4412.5||||4412.5|639.81|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|4412.5||||4412.5|3530|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|EMBLEM HEALTH [2430]|GHI [243003]|4412.5||||4412.5|2603.38|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|4412.5||||4412.5|427.13|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|4412.5||||4412.5|3309.38|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|GEHA [1415]|GEHA - ASA [141503]|4412.5||||4412.5|1765|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|GILSBAR [1425]|GILSBAR [142500]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|4412.5||||4412.5|384.33|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HEALTHNET [1495]|HEALTHNET [149500]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|4412.5||||4412.5|1765|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|4412.5||||4412.5|4412.5|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HORIZON [3625]|HORIZON FEDERAL [362504]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|4412.5||||4412.5|4412.5|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4412.5||||4412.5|2603.38|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|4412.5||||4412.5|2206.25|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|4412.5||||4412.5|384.33|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4412.5||||4412.5|1765|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4412.5||||4412.5|1765|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|MULTIPLAN [1680]|IHC HS [168011]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|MVA [1690]|NJ PLIGA        [169009]|4412.5||||4412.5|4412.5|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|4412.5||||4412.5|2426.88|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4412.5||||4412.5|2426.88|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|4412.5||||4412.5|1765|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|4412.5||||4412.5|2603.38|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|4412.5||||4412.5|2603.38|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|QUALCARE [3725]|QUALCARE PPO [372503]|4412.5||||4412.5|2603.38|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|4412.5||||4412.5|2426.88|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|Self-pay|Self-pay|4412.5||||4412.5|4412.5|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|TRUSTMARK [2030]|STARMARK [203000]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|4412.5||||4412.5|427.13|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4412.5||||4412.5|463.31|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4412.5||||4412.5|463.31|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|4412.5||||4412.5|0|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|4412.5||||4412.5|0|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4412.5||||4412.5||4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4412.5||||4412.5|0|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|4412.5||||4412.5|0|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4412.5||||4412.5|0|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|WEB TPA [2115]|WEB TPA [211500]|4412.5||||4412.5|3750.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|4412.5||||4412.5|1985.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4412.5||||4412.5|1985.63|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4412.5||||4412.5|4412.5|4412.5|384.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|4412.5||||4412.5|2603.38|4412.5|384.33
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|992||||992|882.88|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|992||||992|151.78|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|AETNA [1015]|AETNA LIBERTY [101531]|992||||992|744|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|AETNA [1015]|AETNA PPO [101526]|992||||992|882.88|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|992||||992|882.88|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|992||||992|96.03|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|992||||992|992|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|992||||992|992|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|992||||992|962.24|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|992||||992|962.24|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|992||||992|793.6|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|992||||992|907.08|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|992||||992|907.08|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|992||||992|143.84|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|EMBLEM HEALTH [2430]|GHI [243003]|992||||992|845.18|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|992||||992|96.03|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|992||||992|744|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|GEHA [1415]|GEHA - ASA [141503]|992||||992|882.88|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|GILSBAR [1425]|GILSBAR [142500]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|992||||992|86.4|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HEALTHNET [1495]|HEALTHNET [149500]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|992||||992|0|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|992||||992|992|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HORIZON [3625]|HORIZON FEDERAL [362504]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|992||||992|557.31|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|992||||992|845.18|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|992||||992|496|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|992||||992|86.4|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|992||||992|882.88|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|992||||992|882.88|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|MULTIPLAN [1680]|IHC HS [168011]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|MVA [1690]|NJ PLIGA        [169009]|992||||992|992|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|992||||992|907.08|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|992||||992|907.08|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|992||||992|882.88|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|992||||992|781.7|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|992||||992|845.18|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|QUALCARE [3725]|QUALCARE PPO [372503]|992||||992|845.18|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|992||||992|907.08|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|Self-pay|Self-pay|992||||992|992|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|TRUSTMARK [2030]|STARMARK [203000]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|992||||992|96.03|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|992||||992|104.16|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|992||||992|104.16|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|992||||992|0|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|992||||992|0|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|992||||992|0|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|992||||992|0|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|992||||992|0|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|WEB TPA [2115]|WEB TPA [211500]|992||||992|843.2|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|992||||992||992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|992||||992|992|992|86.4
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|992||||992|781.7|992|86.4
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|656||||656|583.84|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|656||||656|100.37|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|AETNA [1015]|AETNA LIBERTY [101531]|656||||656|492|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|AETNA [1015]|AETNA PPO [101526]|656||||656|583.84|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|656||||656|583.84|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|656||||656|63.5|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|656||||656|656|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|656||||656|656|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|656||||656|636.32|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|656||||656|636.32|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|656||||656|524.8|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|656||||656|599.85|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|656||||656|599.85|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|656||||656|95.12|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|EMBLEM HEALTH [2430]|GHI [243003]|656||||656|558.91|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|656||||656|63.5|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|656||||656|492|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|GEHA [1415]|GEHA - ASA [141503]|656||||656|583.84|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|GILSBAR [1425]|GILSBAR [142500]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|656||||656|57.14|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HEALTHNET [1495]|HEALTHNET [149500]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|656||||656|0|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|656||||656|656|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HORIZON [3625]|HORIZON FEDERAL [362504]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|656||||656|368.54|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|656||||656|558.91|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|656||||656|328|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|656||||656|57.14|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|656||||656|583.84|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|656||||656|583.84|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|MULTIPLAN [1680]|IHC HS [168011]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|MVA [1690]|NJ PLIGA        [169009]|656||||656|656|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|656||||656|599.85|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|656||||656|599.85|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|656||||656|583.84|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|656||||656|516.93|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|656||||656|558.91|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|QUALCARE [3725]|QUALCARE PPO [372503]|656||||656|558.91|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|656||||656|599.85|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|Self-pay|Self-pay|656||||656|656|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|TRUSTMARK [2030]|STARMARK [203000]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|656||||656|63.5|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|656||||656|68.88|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|656||||656|68.88|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|656||||656|0|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|656||||656|0|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|656||||656|0|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|656||||656|0|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|656||||656|0|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|WEB TPA [2115]|WEB TPA [211500]|656||||656|557.6|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|656||||656||656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|656||||656|656|656|57.14
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|656||||656|516.93|656|57.14
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|386.75||||386.75|386.75|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|386.75||||386.75|189.51|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|AETNA [1015]|AETNA LIBERTY [101531]|386.75||||386.75|290.06|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|AETNA [1015]|AETNA PPO [101526]|386.75||||386.75|386.75|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|386.75||||386.75|386.75|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|386.75||||386.75|37.44|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|386.75||||386.75|232.05|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|386.75||||386.75|232.05|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|386.75||||386.75|208.85|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|386.75||||386.75|208.85|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|386.75||||386.75|309.4|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|386.75||||386.75|212.71|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|386.75||||386.75|212.71|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|386.75||||386.75|56.08|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|386.75||||386.75|309.4|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|EMBLEM HEALTH [2430]|GHI [243003]|386.75||||386.75|228.18|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|386.75||||386.75|37.44|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|386.75||||386.75|290.06|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|GEHA [1415]|GEHA - ASA [141503]|386.75||||386.75|386.75|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|GILSBAR [1425]|GILSBAR [142500]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|386.75||||386.75|33.69|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HEALTHNET [1495]|HEALTHNET [149500]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|386.75||||386.75|0|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|386.75||||386.75|386.75|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HORIZON [3625]|HORIZON FEDERAL [362504]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|386.75||||386.75|217.28|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|386.75||||386.75|228.18|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|386.75||||386.75|193.38|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|386.75||||386.75|33.69|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|386.75||||386.75|386.75|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|386.75||||386.75|386.75|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|MULTIPLAN [1680]|IHC HS [168011]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|MVA [1690]|NJ PLIGA        [169009]|386.75||||386.75|386.75|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|386.75||||386.75|212.71|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|386.75||||386.75|212.71|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|386.75||||386.75|386.75|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|386.75||||386.75|228.18|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|386.75||||386.75|228.18|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|QUALCARE [3725]|QUALCARE PPO [372503]|386.75||||386.75|228.18|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|386.75||||386.75|212.71|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|Self-pay|Self-pay|386.75||||386.75|386.75|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|TRUSTMARK [2030]|STARMARK [203000]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|386.75||||386.75|37.44|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|386.75||||386.75|40.61|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|386.75||||386.75|40.61|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|386.75||||386.75|0|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|386.75||||386.75|0|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|386.75||||386.75||386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|386.75||||386.75|0|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|386.75||||386.75|0|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|386.75||||386.75|0|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|WEB TPA [2115]|WEB TPA [211500]|386.75||||386.75|328.74|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|386.75||||386.75|174.04|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|386.75||||386.75|174.04|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|386.75||||386.75|386.75|386.75|33.69
100069|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|386.75||||386.75|228.18|386.75|33.69
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|0.31||||0.31|0.28|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|0.31||||0.31|0.05|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA LIBERTY [101531]|0.31||||0.31|0.23|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA PPO [101526]|0.31||||0.31|0.28|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.31||||0.31|0.28|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|0.31||||0.31|0.03|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|0.31||||0.31|0.31|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|0.31||||0.31|0.31|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|0.31||||0.31|0.3|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|0.31||||0.31|0.3|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|EMPIRE BCBS PPO [115559]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|0.31||||0.31|0.25|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|0.31||||0.31|0.28|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA [1260]|CIGNA INDEMNITY [126019]|0.31||||0.31|0.28|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|0.31||||0.31|0.04|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|GHI [243003]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|0.31||||0.31|0.03|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|0.31||||0.31|0.23|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GEHA [1415]|GEHA - ASA [141503]|0.31||||0.31|0.28|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GILSBAR [1425]|GILSBAR [142500]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|0.31||||0.31|0.03|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHFIRST [2395]|HEALTHFIRST [239500]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|0.31||||0.31|0|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|0.31||||0.31|0.31|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HORIZON [3625]|HORIZON BCBS UNION [362506]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HORIZON [3625]|HORIZON FEDERAL [362504]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HORIZON [3625]|HORIZON PIP AUTO [362505]|0.31||||0.31|0.17|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.31||||0.31|0.26|0.31|0.03
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]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|0.31||||0.31|0.16|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|0.31||||0.31|0.03|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|0.31||||0.31|0.28|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|0.31||||0.31|0.28|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MVA [1690]|NJ PLIGA        [169009]|0.31||||0.31|0.31|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|0.31||||0.31|0.28|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|0.31||||0.31|0.28|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|0.31||||0.31|0.28|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|0.31||||0.31|0.24|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|QUALCARE [3725]|QUALCARE HMO/POS [372501]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|QUALCARE [3725]|QUALCARE PPO [372503]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|0.31||||0.31|0.28|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|Self-pay|Self-pay|0.31||||0.31|0.31|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|0.31||||0.31|0.03|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.31||||0.31|0.03|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UMR [2035]|UMR UNITED HEALTHCARE [203502]|0.31||||0.31|0.03|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|0.31||||0.31|0|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|0.31||||0.31|0|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|0.31||||0.31|0|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|0.31||||0.31|0|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.31||||0.31|0|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WEB TPA [2115]|WEB TPA [211500]|0.31||||0.31|0.26|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|0.31||||0.31||0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|0.31||||0.31|0.31|0.31|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|QUALCARE WC [212530]|0.31||||0.31|0.24|0.31|0.03
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1369.8||||1369.8|1369.8|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1369.8||||1369.8|671.2|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA LIBERTY [101531]|1369.8||||1369.8|1027.35|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA PPO [101526]|1369.8||||1369.8|1369.8|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1369.8||||1369.8|1369.8|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1369.8||||1369.8|1164.33|1369.8|119.31
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|132.6|1369.8|119.31
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||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|1369.8||||1369.8|821.88|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|1369.8||||1369.8|821.88|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|1369.8||||1369.8|739.69|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|1369.8||||1369.8|739.69|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|1369.8||||1369.8|1095.84|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|1369.8||||1369.8|753.39|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|1369.8||||1369.8|753.39|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|1369.8||||1369.8|198.62|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|1369.8||||1369.8|1095.84|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|EMBLEM HEALTH [2430]|GHI [243003]|1369.8||||1369.8|808.18|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|1369.8||||1369.8|132.6|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1369.8||||1369.8|1027.35|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|GEHA [1415]|GEHA - ASA [141503]|1369.8||||1369.8|1369.8|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|GILSBAR [1425]|GILSBAR [142500]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|1369.8||||1369.8|119.31|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HEALTHNET [1495]|HEALTHNET [149500]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|1369.8||||1369.8|0|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|1369.8||||1369.8|1369.8|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|1369.8||||1369.8|769.55|1369.8|119.31
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|808.18|1369.8|119.31
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||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|1369.8||||1369.8|684.9|1369.8|119.31
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|119.31|1369.8|119.31
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||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1369.8||||1369.8|1369.8|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1369.8||||1369.8|1369.8|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MULTIPLAN [1680]|IHC HS [168011]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MVA [1690]|NJ PLIGA        [169009]|1369.8||||1369.8|1369.8|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|1369.8||||1369.8|753.39|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1369.8||||1369.8|753.39|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|1369.8||||1369.8|1369.8|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|1369.8||||1369.8|808.18|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|1369.8||||1369.8|808.18|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|QUALCARE [3725]|QUALCARE PPO [372503]|1369.8||||1369.8|808.18|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1369.8||||1369.8|753.39|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|Self-pay|Self-pay|1369.8||||1369.8|1369.8|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|TRUSTMARK [2030]|STARMARK [203000]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|1369.8||||1369.8|132.6|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1369.8||||1369.8|143.83|1369.8|119.31
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|143.83|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1369.8||||1369.8|0|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|1369.8||||1369.8||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|1369.8||||1369.8|0|1369.8|119.31
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||1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1369.8||||1369.8|0|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|1369.8||||1369.8|0|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1369.8||||1369.8|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1369.8||||1369.8|0|1369.8|119.31
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|1164.33|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|1369.8||||1369.8|616.41|1369.8|119.31
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|616.41|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1369.8||||1369.8|1369.8|1369.8|119.31
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|1369.8||||1369.8|808.18|1369.8|119.31
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|31.52||||31.52|28.05|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.52||||31.52|26.79|31.52|2.75
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|31.52||||31.52|4.82|31.52|2.75
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 NNJ PRIME HMO [102003]|31.52||||31.52||31.52|2.75
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 LIBERTY [101531]|31.52||||31.52|23.64|31.52|2.75
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 MEDICARE SUPPLEMENT [101514]|31.52||||31.52||31.52|2.75
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 PPO [101526]|31.52||||31.52|28.05|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.52||||31.52|28.05|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.52||||31.52|26.79|31.52|2.75
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]|31.52||||31.52|3.05|31.52|2.75
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]|31.52||||31.52||31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|31.52||||31.52|31.52|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|31.52||||31.52|31.52|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|31.52||||31.52|30.57|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|31.52||||31.52|30.57|31.52|2.75
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]|BCBS NJ MEDICARE BLUE [116002]|31.52||||31.52||31.52|2.75
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]|EMPIRE BCBS HMO POS EPO [115558]|31.52||||31.52||31.52|2.75
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]|EMPIRE BCBS PPO [115559]|31.52||||31.52||31.52|2.75
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 BEHAVIORAL HEALTH [126013]|31.52||||31.52|25.22|31.52|2.75
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 HMO POS OPEN ACCESS [126018]|31.52||||31.52|28.82|31.52|2.75
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 INDEMNITY [126019]|31.52||||31.52|28.82|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|31.52||||31.52|4.57|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|31.52||||31.52||31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|EMBLEM HEALTH [2430]|GHI [243003]|31.52||||31.52|26.86|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|31.52||||31.52|3.05|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|31.52||||31.52|23.64|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|GEHA [1415]|GEHA - ASA [141503]|31.52||||31.52|28.05|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|GILSBAR [1425]|GILSBAR [142500]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.52||||31.52|26.79|31.52|2.75
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 MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|31.52||||31.52|2.75|31.52|2.75
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]|HEALTHFIRST [239500]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HEALTHNET [1495]|HEALTHNET [149500]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|31.52||||31.52||31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|31.52||||31.52||31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|31.52||||31.52|0|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|31.52||||31.52|31.52|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|31.52||||31.52||31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|31.52||||31.52||31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|31.52||||31.52||31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|31.52||||31.52||31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|31.52||||31.52||31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|31.52||||31.52|17.71|31.52|2.75
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]|31.52||||31.52|26.86|31.52|2.75
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]|31.52||||31.52||31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|31.52||||31.52|15.76|31.52|2.75
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]|31.52||||31.52|2.75|31.52|2.75
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]|31.52||||31.52||31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|31.52||||31.52||31.52|2.75
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 ARDENT EMPLOYEE [368502]|31.52||||31.52|28.05|31.52|2.75
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 HEALTH [1655]|MERITAIN HEALTH [165500]|31.52||||31.52|28.05|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|MULTIPLAN [1680]|IHC HS [168011]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|MVA [1690]|NJ PLIGA        [169009]|31.52||||31.52|31.52|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|31.52||||31.52|28.82|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|31.52||||31.52|28.82|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|31.52||||31.52|28.05|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|31.52||||31.52||31.52|2.75
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]|GROUP HEALTH COOPERATIVE SCW [178012]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|31.52||||31.52|24.84|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|31.52||||31.52|26.86|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|QUALCARE [3725]|QUALCARE PPO [372503]|31.52||||31.52|26.86|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|31.52||||31.52|28.82|31.52|2.75
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|31.52||||31.52|31.52|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|TRUSTMARK [2030]|STARMARK [203000]|31.52||||31.52|26.79|31.52|2.75
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]|UHCCP [375500]|31.52||||31.52|3.05|31.52|2.75
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 - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.52||||31.52|3.31|31.52|2.75
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]|31.52||||31.52|3.31|31.52|2.75
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 BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|31.52||||31.52|0|31.52|2.75
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 BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|31.52||||31.52||31.52|2.75
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 BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|31.52||||31.52|0|31.52|2.75
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]|31.52||||31.52||31.52|2.75
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 - BIND [206032]|31.52||||31.52|0|31.52|2.75
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]|UNITED HEALTHCARE OXFORD [206009]|31.52||||31.52|0|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|31.52||||31.52|26.79|31.52|2.75
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|31.52||||31.52|0|31.52|2.75
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]|31.52||||31.52|26.79|31.52|2.75
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 MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|31.52||||31.52||31.52|2.75
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]|31.52||||31.52||31.52|2.75
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]|CNA INSURANCE WC [2125100]|31.52||||31.52|31.52|31.52|2.75
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]|QUALCARE WC [212530]|31.52||||31.52|24.84|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|31.52||||31.52|28.05|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|31.52||||31.52|4.82|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AETNA [1015]|AETNA LIBERTY [101531]|31.52||||31.52|23.64|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AETNA [1015]|AETNA PPO [101526]|31.52||||31.52|28.05|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.52||||31.52|28.05|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|31.52||||31.52|3.05|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|31.52||||31.52|31.52|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|31.52||||31.52|31.52|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|31.52||||31.52|30.57|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|31.52||||31.52|30.57|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|31.52||||31.52|25.22|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|31.52||||31.52|28.82|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|31.52||||31.52|28.82|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|31.52||||31.52|4.57|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|EMBLEM HEALTH [2430]|GHI [243003]|31.52||||31.52|26.86|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|31.52||||31.52|3.05|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|31.52||||31.52|23.64|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|GEHA [1415]|GEHA - ASA [141503]|31.52||||31.52|28.05|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|GILSBAR [1425]|GILSBAR [142500]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|31.52||||31.52|2.75|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HEALTHNET [1495]|HEALTHNET [149500]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|31.52||||31.52|0|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|31.52||||31.52|31.52|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HORIZON [3625]|HORIZON FEDERAL [362504]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|31.52||||31.52|17.71|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.52||||31.52|26.86|31.52|2.75
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]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|31.52||||31.52|15.76|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|31.52||||31.52|2.75|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|31.52||||31.52|28.05|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|31.52||||31.52|28.05|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MULTIPLAN [1680]|IHC HS [168011]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MVA [1690]|NJ PLIGA        [169009]|31.52||||31.52|31.52|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|31.52||||31.52|28.82|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|31.52||||31.52|28.82|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|31.52||||31.52|28.05|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|31.52||||31.52|24.84|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|31.52||||31.52|26.86|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|QUALCARE [3725]|QUALCARE PPO [372503]|31.52||||31.52|26.86|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|31.52||||31.52|28.82|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|Self-pay|Self-pay|31.52||||31.52|31.52|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|TRUSTMARK [2030]|STARMARK [203000]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|31.52||||31.52|3.05|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.52||||31.52|3.31|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|31.52||||31.52|3.31|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|31.52||||31.52|0|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|31.52||||31.52|0|31.52|2.75
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]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|31.52||||31.52|0|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|31.52||||31.52|0|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|31.52||||31.52|0|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|WEB TPA [2115]|WEB TPA [211500]|31.52||||31.52|26.79|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|31.52||||31.52||31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|31.52||||31.52|31.52|31.52|2.75
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|31.52||||31.52|24.84|31.52|2.75
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|31.52||||31.52|28.05|31.52|2.75
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|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.52||||31.52|26.79|31.52|2.75
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|31.52||||31.52|4.82|31.52|2.75
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 NNJ PRIME HMO [102003]|31.52||||31.52||31.52|2.75
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 LIBERTY [101531]|31.52||||31.52|23.64|31.52|2.75
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 MEDICARE SUPPLEMENT [101514]|31.52||||31.52||31.52|2.75
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 PPO [101526]|31.52||||31.52|28.05|31.52|2.75
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|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.52||||31.52|28.05|31.52|2.75
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|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.52||||31.52|26.79|31.52|2.75
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]|31.52||||31.52|3.05|31.52|2.75
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]|31.52||||31.52||31.52|2.75
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|31.52||||31.52|31.52|31.52|2.75
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|31.52||||31.52|31.52|31.52|2.75
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|31.52||||31.52|30.57|31.52|2.75
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|31.52||||31.52|30.57|31.52|2.75
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]|BCBS NJ MEDICARE BLUE [116002]|31.52||||31.52||31.52|2.75
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]|EMPIRE BCBS HMO POS EPO [115558]|31.52||||31.52||31.52|2.75
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]|EMPIRE BCBS PPO [115559]|31.52||||31.52||31.52|2.75
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 BEHAVIORAL HEALTH [126013]|31.52||||31.52|25.22|31.52|2.75
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 HMO POS OPEN ACCESS [126018]|31.52||||31.52|28.82|31.52|2.75
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 INDEMNITY [126019]|31.52||||31.52|28.82|31.52|2.75
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|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|31.52||||31.52|4.57|31.52|2.75
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|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|31.52||||31.52||31.52|2.75
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|EMBLEM HEALTH [2430]|GHI [243003]|31.52||||31.52|26.86|31.52|2.75
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|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|31.52||||31.52|3.05|31.52|2.75
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|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|31.52||||31.52|23.64|31.52|2.75
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|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|31.52||||31.52|26.79|31.52|2.75
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|GEHA [1415]|GEHA - ASA [141503]|31.52||||31.52|28.05|31.52|2.75
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|GILSBAR [1425]|GILSBAR [142500]|31.52||||31.52|26.79|31.52|2.75
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|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|31.52||||31.52|26.79|31.52|2.75
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|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.52||||31.52|26.79|31.52|2.75
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 MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|31.52||||31.52|2.75|31.52|2.75
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]|HEALTHFIRST [239500]|31.52||||31.52|26.79|31.52|2.75
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|HEALTHNET [1495]|HEALTHNET [149500]|31.52||||31.52|26.79|31.52|2.75
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|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.52||||31.52|26.79|31.52|2.75
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|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|31.52||||31.52|26.79|31.52|2.75
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|31.52||||31.52||31.52|2.75
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|31.52||||31.52||31.52|2.75
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|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|31.52||||31.52|0|31.52|2.75
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|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|31.52||||31.52|31.52|31.52|2.75
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|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|31.52||||31.52||31.52|2.75
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|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|31.52||||31.52||31.52|2.75
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|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|31.52||||31.52||31.52|2.75
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|HORIZON [3625]|HORIZON BCBS UNION [362506]|31.52||||31.52||31.52|2.75
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|HORIZON [3625]|HORIZON FEDERAL [362504]|31.52||||31.52||31.52|2.75
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|HORIZON [3625]|HORIZON PIP AUTO [362505]|31.52||||31.52|17.71|31.52|2.75
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]|31.52||||31.52|26.86|31.52|2.75
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]|31.52||||31.52||31.52|2.75
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|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|31.52||||31.52|15.76|31.52|2.75
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]|31.52||||31.52|2.75|31.52|2.75
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]|31.52||||31.52||31.52|2.75
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|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.52||||31.52|26.79|31.52|2.75
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|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|31.52||||31.52||31.52|2.75
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 ARDENT EMPLOYEE [368502]|31.52||||31.52|28.05|31.52|2.75
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 HEALTH [1655]|MERITAIN HEALTH [165500]|31.52||||31.52|28.05|31.52|2.75
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|MULTIPLAN [1680]|IHC HS [168011]|31.52||||31.52|26.79|31.52|2.75
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|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.52||||31.52|26.79|31.52|2.75
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|MVA [1690]|NJ PLIGA        [169009]|31.52||||31.52|31.52|31.52|2.75
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|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|31.52||||31.52|28.82|31.52|2.75
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|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|31.52||||31.52|28.82|31.52|2.75
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|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|31.52||||31.52|26.79|31.52|2.75
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|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|31.52||||31.52|28.05|31.52|2.75
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|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.52||||31.52|26.79|31.52|2.75
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|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|31.52||||31.52|26.79|31.52|2.75
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|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|31.52||||31.52||31.52|2.75
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]|GROUP HEALTH COOPERATIVE SCW [178012]|31.52||||31.52|26.79|31.52|2.75
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|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|31.52||||31.52|26.79|31.52|2.75
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|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|31.52||||31.52|24.84|31.52|2.75
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|QUALCARE [3725]|QUALCARE HMO/POS [372501]|31.52||||31.52|26.86|31.52|2.75
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|QUALCARE [3725]|QUALCARE PPO [372503]|31.52||||31.52|26.86|31.52|2.75
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|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|31.52||||31.52|26.79|31.52|2.75
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|31.52||||31.52|28.82|31.52|2.75
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|31.52||||31.52|31.52|31.52|2.75
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|TRUSTMARK [2030]|STARMARK [203000]|31.52||||31.52|26.79|31.52|2.75
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]|UHCCP [375500]|31.52||||31.52|3.05|31.52|2.75
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 - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.52||||31.52|3.31|31.52|2.75
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]|31.52||||31.52|3.31|31.52|2.75
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 BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|31.52||||31.52|0|31.52|2.75
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 BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|31.52||||31.52||31.52|2.75
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 BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|31.52||||31.52|0|31.52|2.75
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]|31.52||||31.52||31.52|2.75
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 - BIND [206032]|31.52||||31.52|0|31.52|2.75
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]|UNITED HEALTHCARE OXFORD [206009]|31.52||||31.52|0|31.52|2.75
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|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|31.52||||31.52|26.79|31.52|2.75
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|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|31.52||||31.52|0|31.52|2.75
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]|31.52||||31.52|26.79|31.52|2.75
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 MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|31.52||||31.52||31.52|2.75
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]|31.52||||31.52||31.52|2.75
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]|CNA INSURANCE WC [2125100]|31.52||||31.52|31.52|31.52|2.75
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]|QUALCARE WC [212530]|31.52||||31.52|24.84|31.52|2.75
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|117||||117|104.13|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|117||||117|17.9|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|AETNA [1015]|AETNA LIBERTY [101531]|117||||117|87.75|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|AETNA [1015]|AETNA PPO [101526]|117||||117|104.13|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|117||||117|104.13|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|117||||117|11.33|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|117||||117|117|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|117||||117|117|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|117||||117|113.49|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|117||||117|113.49|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|117||||117|93.6|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|117||||117|106.98|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|117||||117|106.98|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|117||||117|16.97|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|EMBLEM HEALTH [2430]|GHI [243003]|117||||117|99.68|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|117||||117|11.33|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|117||||117|87.75|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|GEHA [1415]|GEHA - ASA [141503]|117||||117|104.13|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|GILSBAR [1425]|GILSBAR [142500]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|117||||117|10.19|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HEALTHNET [1495]|HEALTHNET [149500]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|117||||117|0|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|117||||117|117|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|117||||117|65.73|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|117||||117|99.68|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|117||||117|58.5|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|117||||117|10.19|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|117||||117|104.13|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|117||||117|104.13|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|MULTIPLAN [1680]|IHC HS [168011]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|MVA [1690]|NJ PLIGA        [169009]|117||||117|117|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|117||||117|106.98|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|117||||117|106.98|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|117||||117|104.13|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|117||||117|92.2|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|117||||117|99.68|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|QUALCARE [3725]|QUALCARE PPO [372503]|117||||117|99.68|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|117||||117|106.98|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|Self-pay|Self-pay|117||||117|117|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|TRUSTMARK [2030]|STARMARK [203000]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|117||||117|11.33|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|117||||117|12.29|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|117||||117|12.29|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|117||||117|0|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|117||||117|0|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|117||||117|0|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|117||||117|0|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|117||||117|0|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|WEB TPA [2115]|WEB TPA [211500]|117||||117|99.45|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|117||||117||117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|117||||117|117|117|10.19
100146|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|EARTIP TYMPANOMETER OD11 MM INFECTION CONTROL MULTIFLANGE LATEX FREE DISPOSABLE ACOUSTIC IMMITTANCE OTOACOUSTIC EMISSION SYSTEM AUDIOMETRIC INSERT EARPHONE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|117||||117|92.2|117|10.19
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|997.5||||997.5|997.5|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|997.5||||997.5|488.78|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AETNA [1015]|AETNA LIBERTY [101531]|997.5||||997.5|748.13|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AETNA [1015]|AETNA PPO [101526]|997.5||||997.5|997.5|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|997.5||||997.5|997.5|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|997.5||||997.5|96.56|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|997.5||||997.5|598.5|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|997.5||||997.5|598.5|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|997.5||||997.5|538.65|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|997.5||||997.5|538.65|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|997.5||||997.5|798|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|997.5||||997.5|548.63|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|997.5||||997.5|548.63|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|997.5||||997.5|144.64|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|997.5||||997.5|798|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|EMBLEM HEALTH [2430]|GHI [243003]|997.5||||997.5|588.53|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|997.5||||997.5|96.56|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|997.5||||997.5|748.13|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|GEHA [1415]|GEHA - ASA [141503]|997.5||||997.5|997.5|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|GILSBAR [1425]|GILSBAR [142500]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|997.5||||997.5|86.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HEALTHNET [1495]|HEALTHNET [149500]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|997.5||||997.5|0|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|997.5||||997.5|997.5|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HORIZON [3625]|HORIZON FEDERAL [362504]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|997.5||||997.5|560.4|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|997.5||||997.5|588.53|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|997.5||||997.5|498.75|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|997.5||||997.5|86.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|997.5||||997.5|997.5|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|997.5||||997.5|997.5|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MULTIPLAN [1680]|IHC HS [168011]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MVA [1690]|NJ PLIGA        [169009]|997.5||||997.5|997.5|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|997.5||||997.5|548.63|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|997.5||||997.5|548.63|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|997.5||||997.5|997.5|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|997.5||||997.5|588.53|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|997.5||||997.5|588.53|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|QUALCARE [3725]|QUALCARE PPO [372503]|997.5||||997.5|588.53|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|997.5||||997.5|548.63|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|Self-pay|Self-pay|997.5||||997.5|997.5|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|TRUSTMARK [2030]|STARMARK [203000]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|997.5||||997.5|96.56|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|997.5||||997.5|104.74|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|997.5||||997.5|104.74|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|997.5||||997.5|0|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|997.5||||997.5|0|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|997.5||||997.5||997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|997.5||||997.5|0|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|997.5||||997.5|0|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|997.5||||997.5|0|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|WEB TPA [2115]|WEB TPA [211500]|997.5||||997.5|847.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|997.5||||997.5|448.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|997.5||||997.5|448.88|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|997.5||||997.5|997.5|997.5|86.88
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|997.5||||997.5|588.53|997.5|86.88
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|90.02|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|548.7|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|81|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|930|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|97.65|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|790.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930|418.5|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
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|90.02|930|81
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||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
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|548.7|930|81
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||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
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|81|930|81
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||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
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|930|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
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|97.65|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
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||930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
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|790.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
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|418.5|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
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|90.02|930|81
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||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
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|548.7|930|81
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||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
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|81|930|81
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||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
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|930|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
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|97.65|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
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||930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
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|790.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
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|418.5|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|90.02|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|548.7|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|81|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|930|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|97.65|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|790.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930|418.5|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
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 NNJ PRIME HMO [102003]|930||||930||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
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|90.02|930|81
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||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
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]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
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|548.7|930|81
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||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
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|81|930|81
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||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
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 ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
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|930|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
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]|UHCCP [375500]|930||||930|90.02|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
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|97.65|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
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||930|81
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 - BIND [206032]|930||||930|0|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
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|790.5|930|81
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
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|418.5|930|81
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]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
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]|QUALCARE WC [212530]|930||||930|548.7|930|81
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|228.75||||228.75|228.75|228.75|19.92
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|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|228.75||||228.75|194.44|228.75|19.92
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|228.75||||228.75|112.09|228.75|19.92
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 NNJ PRIME HMO [102003]|228.75||||228.75||228.75|19.92
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 LIBERTY [101531]|228.75||||228.75|171.56|228.75|19.92
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 MEDICARE SUPPLEMENT [101514]|228.75||||228.75||228.75|19.92
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 PPO [101526]|228.75||||228.75|228.75|228.75|19.92
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|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|228.75||||228.75|228.75|228.75|19.92
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|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|228.75||||228.75|194.44|228.75|19.92
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]|228.75||||228.75|22.14|228.75|19.92
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]|228.75||||228.75||228.75|19.92
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|228.75||||228.75|137.25|228.75|19.92
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|228.75||||228.75|137.25|228.75|19.92
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|228.75||||228.75|123.53|228.75|19.92
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|228.75||||228.75|123.53|228.75|19.92
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]|BCBS NJ MEDICARE BLUE [116002]|228.75||||228.75||228.75|19.92
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]|EMPIRE BCBS HMO POS EPO [115558]|228.75||||228.75||228.75|19.92
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]|EMPIRE BCBS PPO [115559]|228.75||||228.75||228.75|19.92
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 BEHAVIORAL HEALTH [126013]|228.75||||228.75|183|228.75|19.92
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 HMO POS OPEN ACCESS [126018]|228.75||||228.75|125.81|228.75|19.92
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 INDEMNITY [126019]|228.75||||228.75|125.81|228.75|19.92
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|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|228.75||||228.75|33.17|228.75|19.92
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|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|228.75||||228.75|183|228.75|19.92
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|EMBLEM HEALTH [2430]|GHI [243003]|228.75||||228.75|134.96|228.75|19.92
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|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|228.75||||228.75|22.14|228.75|19.92
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|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|228.75||||228.75|171.56|228.75|19.92
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|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|228.75||||228.75|194.44|228.75|19.92
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|GEHA [1415]|GEHA - ASA [141503]|228.75||||228.75|228.75|228.75|19.92
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|GILSBAR [1425]|GILSBAR [142500]|228.75||||228.75|194.44|228.75|19.92
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|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|228.75||||228.75|194.44|228.75|19.92
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|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|228.75||||228.75|194.44|228.75|19.92
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 MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|228.75||||228.75|19.92|228.75|19.92
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]|HEALTHFIRST [239500]|228.75||||228.75|194.44|228.75|19.92
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|HEALTHNET [1495]|HEALTHNET [149500]|228.75||||228.75|194.44|228.75|19.92
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|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|228.75||||228.75|194.44|228.75|19.92
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|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|228.75||||228.75|194.44|228.75|19.92
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|228.75||||228.75||228.75|19.92
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|228.75||||228.75||228.75|19.92
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|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|228.75||||228.75|0|228.75|19.92
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|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|228.75||||228.75|228.75|228.75|19.92
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|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON BCBS UNION [362506]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON FEDERAL [362504]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON PIP AUTO [362505]|228.75||||228.75|128.51|228.75|19.92
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]|228.75||||228.75|134.96|228.75|19.92
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]|228.75||||228.75||228.75|19.92
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|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|228.75||||228.75|114.38|228.75|19.92
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]|228.75||||228.75|19.92|228.75|19.92
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]|228.75||||228.75||228.75|19.92
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|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|228.75||||228.75|194.44|228.75|19.92
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|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|228.75||||228.75||228.75|19.92
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 ARDENT EMPLOYEE [368502]|228.75||||228.75|228.75|228.75|19.92
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 HEALTH [1655]|MERITAIN HEALTH [165500]|228.75||||228.75|228.75|228.75|19.92
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|MULTIPLAN [1680]|IHC HS [168011]|228.75||||228.75|194.44|228.75|19.92
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|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|228.75||||228.75|194.44|228.75|19.92
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|MVA [1690]|NJ PLIGA        [169009]|228.75||||228.75|228.75|228.75|19.92
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|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|228.75||||228.75|125.81|228.75|19.92
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|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|228.75||||228.75|125.81|228.75|19.92
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|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|228.75||||228.75|194.44|228.75|19.92
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|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|228.75||||228.75|228.75|228.75|19.92
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|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|228.75||||228.75|194.44|228.75|19.92
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|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|228.75||||228.75|194.44|228.75|19.92
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|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|228.75||||228.75||228.75|19.92
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]|GROUP HEALTH COOPERATIVE SCW [178012]|228.75||||228.75|194.44|228.75|19.92
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|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|228.75||||228.75|194.44|228.75|19.92
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|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|228.75||||228.75|134.96|228.75|19.92
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|QUALCARE [3725]|QUALCARE HMO/POS [372501]|228.75||||228.75|134.96|228.75|19.92
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|QUALCARE [3725]|QUALCARE PPO [372503]|228.75||||228.75|134.96|228.75|19.92
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|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|228.75||||228.75|194.44|228.75|19.92
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|228.75||||228.75|125.81|228.75|19.92
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|228.75||||228.75|228.75|228.75|19.92
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|TRUSTMARK [2030]|STARMARK [203000]|228.75||||228.75|194.44|228.75|19.92
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]|UHCCP [375500]|228.75||||228.75|22.14|228.75|19.92
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 - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|228.75||||228.75|24.02|228.75|19.92
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]|228.75||||228.75|24.02|228.75|19.92
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 BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|228.75||||228.75|0|228.75|19.92
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 BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|228.75||||228.75||228.75|19.92
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 BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|228.75||||228.75|0|228.75|19.92
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]|228.75||||228.75||228.75|19.92
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 - BIND [206032]|228.75||||228.75|0|228.75|19.92
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]|UNITED HEALTHCARE OXFORD [206009]|228.75||||228.75|0|228.75|19.92
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|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|228.75||||228.75|194.44|228.75|19.92
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|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|228.75||||228.75|0|228.75|19.92
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]|228.75||||228.75|194.44|228.75|19.92
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 MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|228.75||||228.75|102.94|228.75|19.92
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]|228.75||||228.75|102.94|228.75|19.92
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]|CNA INSURANCE WC [2125100]|228.75||||228.75|228.75|228.75|19.92
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]|QUALCARE WC [212530]|228.75||||228.75|134.96|228.75|19.92
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|90.02|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|548.7|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|81|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|930|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|97.65|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|790.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930|418.5|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
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|90.02|930|81
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||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
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|548.7|930|81
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||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
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|81|930|81
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||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
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|930|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
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|97.65|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
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||930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
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|790.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
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|418.5|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|90.02|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|548.7|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|81|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|930|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|97.65|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|790.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930|418.5|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
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 NNJ PRIME HMO [102003]|930||||930||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
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|90.02|930|81
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||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
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]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
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|548.7|930|81
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||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
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|81|930|81
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||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
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 ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
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|930|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
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]|UHCCP [375500]|930||||930|90.02|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
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|97.65|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
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||930|81
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 - BIND [206032]|930||||930|0|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
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|790.5|930|81
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
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|418.5|930|81
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]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
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]|QUALCARE WC [212530]|930||||930|548.7|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|90.02|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|548.7|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|81|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|930|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|97.65|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|790.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930|418.5|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
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 NNJ PRIME HMO [102003]|930||||930||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
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|90.02|930|81
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||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
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]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
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|548.7|930|81
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||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
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|81|930|81
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||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
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 ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
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|930|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
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]|UHCCP [375500]|930||||930|90.02|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
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|97.65|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
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||930|81
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 - BIND [206032]|930||||930|0|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
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|790.5|930|81
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
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|418.5|930|81
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]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
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]|QUALCARE WC [212530]|930||||930|548.7|930|81
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|228.75||||228.75|228.75|228.75|19.92
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|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|228.75||||228.75|194.44|228.75|19.92
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|228.75||||228.75|112.09|228.75|19.92
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 NNJ PRIME HMO [102003]|228.75||||228.75||228.75|19.92
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 LIBERTY [101531]|228.75||||228.75|171.56|228.75|19.92
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 MEDICARE SUPPLEMENT [101514]|228.75||||228.75||228.75|19.92
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 PPO [101526]|228.75||||228.75|228.75|228.75|19.92
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|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|228.75||||228.75|228.75|228.75|19.92
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|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|228.75||||228.75|194.44|228.75|19.92
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]|228.75||||228.75|22.14|228.75|19.92
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]|228.75||||228.75||228.75|19.92
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|228.75||||228.75|137.25|228.75|19.92
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|228.75||||228.75|137.25|228.75|19.92
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|228.75||||228.75|123.53|228.75|19.92
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|228.75||||228.75|123.53|228.75|19.92
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]|BCBS NJ MEDICARE BLUE [116002]|228.75||||228.75||228.75|19.92
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]|EMPIRE BCBS HMO POS EPO [115558]|228.75||||228.75||228.75|19.92
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]|EMPIRE BCBS PPO [115559]|228.75||||228.75||228.75|19.92
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 BEHAVIORAL HEALTH [126013]|228.75||||228.75|183|228.75|19.92
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 HMO POS OPEN ACCESS [126018]|228.75||||228.75|125.81|228.75|19.92
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 INDEMNITY [126019]|228.75||||228.75|125.81|228.75|19.92
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|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|228.75||||228.75|33.17|228.75|19.92
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|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|228.75||||228.75|183|228.75|19.92
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|EMBLEM HEALTH [2430]|GHI [243003]|228.75||||228.75|134.96|228.75|19.92
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|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|228.75||||228.75|22.14|228.75|19.92
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|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|228.75||||228.75|171.56|228.75|19.92
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|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|228.75||||228.75|194.44|228.75|19.92
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|GEHA [1415]|GEHA - ASA [141503]|228.75||||228.75|228.75|228.75|19.92
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|GILSBAR [1425]|GILSBAR [142500]|228.75||||228.75|194.44|228.75|19.92
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|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|228.75||||228.75|194.44|228.75|19.92
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|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|228.75||||228.75|194.44|228.75|19.92
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 MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|228.75||||228.75|19.92|228.75|19.92
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]|HEALTHFIRST [239500]|228.75||||228.75|194.44|228.75|19.92
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|HEALTHNET [1495]|HEALTHNET [149500]|228.75||||228.75|194.44|228.75|19.92
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|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|228.75||||228.75|194.44|228.75|19.92
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|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|228.75||||228.75|194.44|228.75|19.92
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|228.75||||228.75||228.75|19.92
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|228.75||||228.75||228.75|19.92
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|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|228.75||||228.75|0|228.75|19.92
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|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|228.75||||228.75|228.75|228.75|19.92
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|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON BCBS UNION [362506]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON FEDERAL [362504]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON PIP AUTO [362505]|228.75||||228.75|128.51|228.75|19.92
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]|228.75||||228.75|134.96|228.75|19.92
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]|228.75||||228.75||228.75|19.92
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|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|228.75||||228.75|114.38|228.75|19.92
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]|228.75||||228.75|19.92|228.75|19.92
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]|228.75||||228.75||228.75|19.92
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|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|228.75||||228.75|194.44|228.75|19.92
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|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|228.75||||228.75||228.75|19.92
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 ARDENT EMPLOYEE [368502]|228.75||||228.75|228.75|228.75|19.92
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 HEALTH [1655]|MERITAIN HEALTH [165500]|228.75||||228.75|228.75|228.75|19.92
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|MULTIPLAN [1680]|IHC HS [168011]|228.75||||228.75|194.44|228.75|19.92
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|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|228.75||||228.75|194.44|228.75|19.92
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|MVA [1690]|NJ PLIGA        [169009]|228.75||||228.75|228.75|228.75|19.92
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|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|228.75||||228.75|125.81|228.75|19.92
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|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|228.75||||228.75|125.81|228.75|19.92
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|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|228.75||||228.75|194.44|228.75|19.92
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|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|228.75||||228.75|228.75|228.75|19.92
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|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|228.75||||228.75|194.44|228.75|19.92
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|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|228.75||||228.75|194.44|228.75|19.92
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|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|228.75||||228.75||228.75|19.92
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]|GROUP HEALTH COOPERATIVE SCW [178012]|228.75||||228.75|194.44|228.75|19.92
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|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|228.75||||228.75|194.44|228.75|19.92
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|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|228.75||||228.75|134.96|228.75|19.92
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|QUALCARE [3725]|QUALCARE HMO/POS [372501]|228.75||||228.75|134.96|228.75|19.92
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|QUALCARE [3725]|QUALCARE PPO [372503]|228.75||||228.75|134.96|228.75|19.92
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|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|228.75||||228.75|194.44|228.75|19.92
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|228.75||||228.75|125.81|228.75|19.92
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|228.75||||228.75|228.75|228.75|19.92
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|TRUSTMARK [2030]|STARMARK [203000]|228.75||||228.75|194.44|228.75|19.92
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]|UHCCP [375500]|228.75||||228.75|22.14|228.75|19.92
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 - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|228.75||||228.75|24.02|228.75|19.92
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]|228.75||||228.75|24.02|228.75|19.92
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 BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|228.75||||228.75|0|228.75|19.92
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 BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|228.75||||228.75||228.75|19.92
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 BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|228.75||||228.75|0|228.75|19.92
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]|228.75||||228.75||228.75|19.92
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 - BIND [206032]|228.75||||228.75|0|228.75|19.92
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]|UNITED HEALTHCARE OXFORD [206009]|228.75||||228.75|0|228.75|19.92
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|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|228.75||||228.75|194.44|228.75|19.92
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|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|228.75||||228.75|0|228.75|19.92
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]|228.75||||228.75|194.44|228.75|19.92
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 MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|228.75||||228.75|102.94|228.75|19.92
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]|228.75||||228.75|102.94|228.75|19.92
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]|CNA INSURANCE WC [2125100]|228.75||||228.75|228.75|228.75|19.92
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]|QUALCARE WC [212530]|228.75||||228.75|134.96|228.75|19.92
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|90.02|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|548.7|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|81|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|930|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|97.65|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|790.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930|418.5|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
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 NNJ PRIME HMO [102003]|930||||930||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
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|90.02|930|81
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||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
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]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
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|548.7|930|81
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||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
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|81|930|81
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||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
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 ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
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|930|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
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]|UHCCP [375500]|930||||930|90.02|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
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|97.65|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
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||930|81
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 - BIND [206032]|930||||930|0|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
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|790.5|930|81
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
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|418.5|930|81
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]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
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]|QUALCARE WC [212530]|930||||930|548.7|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|90.02|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|548.7|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|81|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|930|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|97.65|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|790.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930|418.5|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
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|90.02|930|81
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||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
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|548.7|930|81
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||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
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|81|930|81
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||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
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|930|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
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|97.65|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
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||930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
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|790.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
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|418.5|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|90.02|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|548.7|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|81|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|930|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|97.65|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|790.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930|418.5|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|228.75||||228.75|228.75|228.75|19.92
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|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|228.75||||228.75|194.44|228.75|19.92
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|228.75||||228.75|112.09|228.75|19.92
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 NNJ PRIME HMO [102003]|228.75||||228.75||228.75|19.92
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 LIBERTY [101531]|228.75||||228.75|171.56|228.75|19.92
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 MEDICARE SUPPLEMENT [101514]|228.75||||228.75||228.75|19.92
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 PPO [101526]|228.75||||228.75|228.75|228.75|19.92
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|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|228.75||||228.75|228.75|228.75|19.92
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|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|228.75||||228.75|194.44|228.75|19.92
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]|228.75||||228.75|22.14|228.75|19.92
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]|228.75||||228.75||228.75|19.92
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|228.75||||228.75|137.25|228.75|19.92
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|228.75||||228.75|137.25|228.75|19.92
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|228.75||||228.75|123.53|228.75|19.92
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|228.75||||228.75|123.53|228.75|19.92
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]|BCBS NJ MEDICARE BLUE [116002]|228.75||||228.75||228.75|19.92
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]|EMPIRE BCBS HMO POS EPO [115558]|228.75||||228.75||228.75|19.92
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]|EMPIRE BCBS PPO [115559]|228.75||||228.75||228.75|19.92
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 BEHAVIORAL HEALTH [126013]|228.75||||228.75|183|228.75|19.92
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 HMO POS OPEN ACCESS [126018]|228.75||||228.75|125.81|228.75|19.92
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 INDEMNITY [126019]|228.75||||228.75|125.81|228.75|19.92
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|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|228.75||||228.75|33.17|228.75|19.92
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|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|228.75||||228.75|183|228.75|19.92
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|EMBLEM HEALTH [2430]|GHI [243003]|228.75||||228.75|134.96|228.75|19.92
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|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|228.75||||228.75|22.14|228.75|19.92
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|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|228.75||||228.75|171.56|228.75|19.92
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|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|228.75||||228.75|194.44|228.75|19.92
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|GEHA [1415]|GEHA - ASA [141503]|228.75||||228.75|228.75|228.75|19.92
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|GILSBAR [1425]|GILSBAR [142500]|228.75||||228.75|194.44|228.75|19.92
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|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|228.75||||228.75|194.44|228.75|19.92
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|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|228.75||||228.75|194.44|228.75|19.92
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 MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|228.75||||228.75|19.92|228.75|19.92
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]|HEALTHFIRST [239500]|228.75||||228.75|194.44|228.75|19.92
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|HEALTHNET [1495]|HEALTHNET [149500]|228.75||||228.75|194.44|228.75|19.92
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|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|228.75||||228.75|194.44|228.75|19.92
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|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|228.75||||228.75|194.44|228.75|19.92
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|228.75||||228.75||228.75|19.92
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|228.75||||228.75||228.75|19.92
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|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|228.75||||228.75|0|228.75|19.92
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|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|228.75||||228.75|228.75|228.75|19.92
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|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON BCBS UNION [362506]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON FEDERAL [362504]|228.75||||228.75||228.75|19.92
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|HORIZON [3625]|HORIZON PIP AUTO [362505]|228.75||||228.75|128.51|228.75|19.92
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]|228.75||||228.75|134.96|228.75|19.92
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]|228.75||||228.75||228.75|19.92
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|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|228.75||||228.75|114.38|228.75|19.92
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]|228.75||||228.75|19.92|228.75|19.92
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]|228.75||||228.75||228.75|19.92
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|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|228.75||||228.75|194.44|228.75|19.92
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|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|228.75||||228.75||228.75|19.92
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 ARDENT EMPLOYEE [368502]|228.75||||228.75|228.75|228.75|19.92
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 HEALTH [1655]|MERITAIN HEALTH [165500]|228.75||||228.75|228.75|228.75|19.92
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|MULTIPLAN [1680]|IHC HS [168011]|228.75||||228.75|194.44|228.75|19.92
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|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|228.75||||228.75|194.44|228.75|19.92
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|MVA [1690]|NJ PLIGA        [169009]|228.75||||228.75|228.75|228.75|19.92
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|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|228.75||||228.75|125.81|228.75|19.92
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|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|228.75||||228.75|125.81|228.75|19.92
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|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|228.75||||228.75|194.44|228.75|19.92
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|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|228.75||||228.75|228.75|228.75|19.92
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|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|228.75||||228.75|194.44|228.75|19.92
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|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|228.75||||228.75|194.44|228.75|19.92
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|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|228.75||||228.75||228.75|19.92
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]|GROUP HEALTH COOPERATIVE SCW [178012]|228.75||||228.75|194.44|228.75|19.92
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|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|228.75||||228.75|194.44|228.75|19.92
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|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|228.75||||228.75|134.96|228.75|19.92
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|QUALCARE [3725]|QUALCARE HMO/POS [372501]|228.75||||228.75|134.96|228.75|19.92
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|QUALCARE [3725]|QUALCARE PPO [372503]|228.75||||228.75|134.96|228.75|19.92
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|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|228.75||||228.75|194.44|228.75|19.92
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|228.75||||228.75|125.81|228.75|19.92
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|228.75||||228.75|228.75|228.75|19.92
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|TRUSTMARK [2030]|STARMARK [203000]|228.75||||228.75|194.44|228.75|19.92
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]|UHCCP [375500]|228.75||||228.75|22.14|228.75|19.92
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 - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|228.75||||228.75|24.02|228.75|19.92
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]|228.75||||228.75|24.02|228.75|19.92
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 BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|228.75||||228.75|0|228.75|19.92
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 BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|228.75||||228.75||228.75|19.92
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 BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|228.75||||228.75|0|228.75|19.92
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]|228.75||||228.75||228.75|19.92
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 - BIND [206032]|228.75||||228.75|0|228.75|19.92
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]|UNITED HEALTHCARE OXFORD [206009]|228.75||||228.75|0|228.75|19.92
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|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|228.75||||228.75|194.44|228.75|19.92
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|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|228.75||||228.75|0|228.75|19.92
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]|228.75||||228.75|194.44|228.75|19.92
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 MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|228.75||||228.75|102.94|228.75|19.92
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]|228.75||||228.75|102.94|228.75|19.92
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]|CNA INSURANCE WC [2125100]|228.75||||228.75|228.75|228.75|19.92
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]|QUALCARE WC [212530]|228.75||||228.75|134.96|228.75|19.92
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
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 NNJ PRIME HMO [102003]|930||||930||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
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|90.02|930|81
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||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
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]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
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|548.7|930|81
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||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
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|81|930|81
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||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
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 ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
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|930|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
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]|UHCCP [375500]|930||||930|90.02|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
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|97.65|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
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||930|81
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 - BIND [206032]|930||||930|0|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
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|790.5|930|81
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
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|418.5|930|81
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]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
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]|QUALCARE WC [212530]|930||||930|548.7|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|90.02|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|548.7|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|81|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|930|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|97.65|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|790.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930|418.5|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
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 NNJ PRIME HMO [102003]|930||||930||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
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|90.02|930|81
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||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
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]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
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|548.7|930|81
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||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
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|81|930|81
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||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
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 ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
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|930|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
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]|UHCCP [375500]|930||||930|90.02|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
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|97.65|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
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||930|81
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 - BIND [206032]|930||||930|0|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
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|790.5|930|81
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
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|418.5|930|81
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]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
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]|QUALCARE WC [212530]|930||||930|548.7|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|90.02|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|548.7|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|81|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|930|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|97.65|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|790.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930|418.5|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
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 NNJ PRIME HMO [102003]|930||||930||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
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|90.02|930|81
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||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
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]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
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|548.7|930|81
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||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
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|81|930|81
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||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
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 ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
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|930|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
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]|UHCCP [375500]|930||||930|90.02|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
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|97.65|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
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||930|81
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 - BIND [206032]|930||||930|0|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
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|790.5|930|81
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
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|418.5|930|81
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]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
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]|QUALCARE WC [212530]|930||||930|548.7|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|90.02|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|548.7|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|81|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|930|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|97.65|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|790.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930|418.5|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
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|90.02|930|81
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||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
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|548.7|930|81
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||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
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|81|930|81
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||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
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|930|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
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|97.65|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
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||930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
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|790.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
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|418.5|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|90.02|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|548.7|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|81|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|930|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|97.65|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|790.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930|418.5|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
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 NNJ PRIME HMO [102003]|930||||930||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
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|90.02|930|81
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||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
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]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
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|548.7|930|81
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||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
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|81|930|81
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||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
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 ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
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|930|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
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]|UHCCP [375500]|930||||930|90.02|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
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|97.65|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
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||930|81
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 - BIND [206032]|930||||930|0|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
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|790.5|930|81
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
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|418.5|930|81
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]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
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]|QUALCARE WC [212530]|930||||930|548.7|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|90.02|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|548.7|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|81|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|930|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|97.65|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|790.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930|418.5|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
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|90.02|930|81
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||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
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|548.7|930|81
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||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
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|81|930|81
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||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
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|930|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
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|97.65|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
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||930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
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|790.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
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|418.5|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|930||||930|930|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|930||||930|455.7|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA LIBERTY [101531]|930||||930|697.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA PPO [101526]|930||||930|930|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930||||930|930|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|930||||930|90.02|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|930||||930|558|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|930||||930|558|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|930||||930|502.2|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|930||||930|502.2|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|930||||930|744|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|930||||930|511.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|930||||930|511.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|930||||930|134.85|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|930||||930|744|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|GHI [243003]|930||||930|548.7|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|930||||930|90.02|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|930||||930|697.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|930||||930|930|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GILSBAR [1425]|GILSBAR [142500]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|930||||930|81|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|930||||930|0|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|930||||930|930|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON FEDERAL [362504]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|930||||930|522.47|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930||||930|548.7|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|930||||930|465|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|930||||930|81|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|930||||930|930|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|930||||930|930|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVA [1690]|NJ PLIGA        [169009]|930||||930|930|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|930||||930|511.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|930||||930|511.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|930||||930|930|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|930||||930|548.7|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|930||||930|548.7|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|QUALCARE [3725]|QUALCARE PPO [372503]|930||||930|548.7|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|930||||930|511.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|930||||930|930|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|930||||930|90.02|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930||||930|97.65|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|930||||930|97.65|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|930||||930|0|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL MANAGED MEDICARE [2201]|UNITED MANAGED MEDICARE BEHAVIORAL [220100]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED BEHAVIORAL [2200]|UNITED BEHAVIORAL NETWORK [220001]|930||||930|0|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930||||930||930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|930||||930|0|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|930||||930|0|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|930||||930|0|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WEB TPA [2115]|WEB TPA [211500]|930||||930|790.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICAID REPLACEMENT [3770]|WELLCARE MEDICAID [377500]|930||||930|418.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|930||||930|418.5|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|930||||930|930|930|81
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|QUALCARE WC [212530]|930||||930|548.7|930|81
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|228.75||||228.75|228.75|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|228.75||||228.75|194.44|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|228.75||||228.75|112.09|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 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 NNJ PRIME HMO [102003]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA LIBERTY [101531]|228.75||||228.75|171.56|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA PPO [101526]|228.75||||228.75|228.75|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|228.75||||228.75|228.75|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|228.75||||228.75|194.44|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 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]|228.75||||228.75|22.14|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 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]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|228.75||||228.75|137.25|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|228.75||||228.75|137.25|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|228.75||||228.75|123.53|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|228.75||||228.75|123.53|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BCBS NJ MEDICARE BLUE [116002]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|EMPIRE BCBS PPO [115559]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA BEHAVIORAL HEALTH [126013]|228.75||||228.75|183|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|228.75||||228.75|125.81|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA INDEMNITY [126019]|228.75||||228.75|125.81|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|228.75||||228.75|33.17|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|228.75||||228.75|183|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|EMBLEM HEALTH [2430]|GHI [243003]|228.75||||228.75|134.96|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|228.75||||228.75|22.14|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|228.75||||228.75|171.56|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|228.75||||228.75|194.44|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GEHA [1415]|GEHA - ASA [141503]|228.75||||228.75|228.75|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GILSBAR [1425]|GILSBAR [142500]|228.75||||228.75|194.44|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|228.75||||228.75|194.44|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|228.75||||228.75|194.44|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|228.75||||228.75|19.92|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|228.75||||228.75|194.44|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|228.75||||228.75|194.44|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|228.75||||228.75|194.44|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|228.75||||228.75|194.44|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|BRAVEN HEALTH MEDICARE ADVANTAGE HMO [363005]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON BCBS MED ADV [363000]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|228.75||||228.75|0|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HORIZON [3625]|1199J NEW JERSEY BENEFIT FUND [362508]|228.75||||228.75|228.75|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HORIZON [3625]|HORIZON BCBS HMO POS EPO [362500]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HORIZON [3625]|HORIZON BCBS UNION [362506]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HORIZON [3625]|HORIZON FEDERAL [362504]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HORIZON [3625]|HORIZON PIP AUTO [362505]|228.75||||228.75|128.51|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 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]|228.75||||228.75|134.96|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 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]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|228.75||||228.75|114.38|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 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]|228.75||||228.75|19.92|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 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]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|228.75||||228.75|194.44|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MCS ADVANTAGE MEDICARE REPLACEMENT [3655]|MCS ADVANTAGE INC [365500]|228.75||||228.75||228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 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 ARDENT EMPLOYEE [368502]|228.75||||228.75|228.75|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|228.75||||228.75|228.75|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|228.75||||228.75|194.44|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|228.75||||228.75|194.44|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MVA [1690]|NJ PLIGA        [169009]|228.75||||228.75|228.75|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|228.75||||228.75|125.81|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|228.75||||228.75|125.81|228.75|19.92
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX