"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|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|0|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|0|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|0|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|10||||10|3.3|9.3|2.1
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]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
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]|10||||10|0|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
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]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|2.55|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|10||||10|9|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
1000|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 2 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|3824.36||||3824.36|1338.53|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3824.36||||3824.36|0|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3824.36||||3824.36|0|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3824.36||||3824.36|0|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3824.36||||3824.36|0|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3824.36||||3824.36|1644.48|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3824.36||||3824.36|0|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3824.36||||3824.36|1912.18|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3824.36||||3824.36|2485.84|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CORESOURCE [1315]|CORESOURCE [131500]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3824.36||||3824.36|1873.94|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3824.36||||3824.36|1169.3|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|GEHA [1415]|GEHA [141500]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3824.36||||3824.36|1338.53|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HEALTHNET [1495]|HEALTHNET [149500]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3824.36||||3824.36|1644.48|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3824.36||||3824.36|3556.66|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3824.36||||3824.36|1262.04|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3824.36||||3824.36|1912.18|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3824.36||||3824.36|0|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MULTIPLAN [1680]|HMA [168003]|3824.36||||3824.36|1338.53|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MULTIPLAN [1680]|IHC HS [168011]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3824.36||||3824.36|0|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|Self-pay|Self-pay|3824.36||||3824.36|1147.31|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3824.36||||3824.36|803.12|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|TRUSTMARK [2030]|STARMARK [203000]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3824.36||||3824.36|975.6|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UMR [2035]|UMR OPTIONS [203501]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3824.36||||3824.36|0|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|3824.36||||3824.36|3441.93|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3824.36||||3824.36|1169.3|3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3824.36||||3824.36||3556.66|803.12
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3824.36||||3824.36|1912.18|3556.66|803.12
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|48.36||||48.36|0|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48.36||||48.36|0|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48.36||||48.36|0|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|48.36||||48.36|0|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48.36||||48.36|0|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48.36||||48.36|20.79|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|48.36||||48.36|0|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|48.36||||48.36|24.18|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48.36||||48.36|31.43|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|48.36||||48.36|0|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|48.36||||48.36|17.89|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GEHA [1415]|GEHA [141500]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48.36||||48.36|20.79|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|48.36||||48.36|44.97|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|48.36||||48.36|15.96|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48.36||||48.36|0|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48.36||||48.36|0|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|HMA [168003]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|48.36||||48.36|0|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|Self-pay|Self-pay|48.36||||48.36|14.51|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48.36||||48.36|10.16|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48.36||||48.36|12.34|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UMR [2035]|UMR OPTIONS [203501]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48.36||||48.36|0|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|48.36||||48.36|43.52|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|48.36||||48.36|17.89|44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|48.36||||48.36||44.97|10.16
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|48.36||||48.36|24.18|44.97|10.16
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|AETNA ACO WILCO [101532]|5712.97||||5712.97|1999.54|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5712.97||||5712.97|0|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5712.97||||5712.97|0|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5712.97||||5712.97|0|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5712.97||||5712.97|0|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5712.97||||5712.97|2456.58|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5712.97||||5712.97|0|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5712.97||||5712.97|2856.49|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5712.97||||5712.97|3713.43|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CORESOURCE [1315]|CORESOURCE [131500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5712.97||||5712.97|2799.36|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5712.97||||5712.97|1169.3|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|GEHA [1415]|GEHA [141500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5712.97||||5712.97|1999.54|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHNET [1495]|HEALTHNET [149500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5712.97||||5712.97|2456.58|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5712.97||||5712.97|5313.06|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5712.97||||5712.97|1885.28|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5712.97||||5712.97|2856.49|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5712.97||||5712.97|0|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MULTIPLAN [1680]|HMA [168003]|5712.97||||5712.97|1999.54|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MULTIPLAN [1680]|IHC HS [168011]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5712.97||||5712.97|0|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|Self-pay|Self-pay|5712.97||||5712.97|1713.89|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5712.97||||5712.97|1199.72|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|TRUSTMARK [2030]|STARMARK [203000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5712.97||||5712.97|1457.38|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR [2035]|UMR OPTIONS [203501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5712.97||||5712.97|0|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|5712.97||||5712.97|5141.67|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5712.97||||5712.97|1169.3|5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5712.97||||5712.97||5313.06|1169.3
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5712.97||||5712.97|2856.49|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|AETNA ACO WILCO [101532]|5712.97||||5712.97|1999.54|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5712.97||||5712.97|0|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5712.97||||5712.97|0|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5712.97||||5712.97|0|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5712.97||||5712.97|0|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5712.97||||5712.97|2456.58|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5712.97||||5712.97|0|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5712.97||||5712.97|2856.49|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5712.97||||5712.97|3713.43|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CORESOURCE [1315]|CORESOURCE [131500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5712.97||||5712.97|2799.36|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5712.97||||5712.97|1169.3|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|GEHA [1415]|GEHA [141500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5712.97||||5712.97|1999.54|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHNET [1495]|HEALTHNET [149500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5712.97||||5712.97|2456.58|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5712.97||||5712.97|5313.06|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5712.97||||5712.97|1885.28|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5712.97||||5712.97|2856.49|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5712.97||||5712.97|0|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MULTIPLAN [1680]|HMA [168003]|5712.97||||5712.97|1999.54|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MULTIPLAN [1680]|IHC HS [168011]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5712.97||||5712.97|0|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|Self-pay|Self-pay|5712.97||||5712.97|1713.89|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5712.97||||5712.97|1199.72|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|TRUSTMARK [2030]|STARMARK [203000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5712.97||||5712.97|1457.38|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR [2035]|UMR OPTIONS [203501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5712.97||||5712.97|0|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|5712.97||||5712.97|5141.67|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5712.97||||5712.97|1169.3|5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5712.97||||5712.97||5313.06|1169.3
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5712.97||||5712.97|2856.49|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|AETNA ACO WILCO [101532]|5712.97||||5712.97|1999.54|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5712.97||||5712.97|0|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5712.97||||5712.97|0|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5712.97||||5712.97|0|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5712.97||||5712.97|0|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5712.97||||5712.97|2456.58|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5712.97||||5712.97|0|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5712.97||||5712.97|2856.49|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5712.97||||5712.97|3713.43|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|CORESOURCE [1315]|CORESOURCE [131500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5712.97||||5712.97|2799.36|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5712.97||||5712.97|1169.3|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|GEHA [1415]|GEHA [141500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5712.97||||5712.97|1999.54|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHNET [1495]|HEALTHNET [149500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5712.97||||5712.97|2456.58|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5712.97||||5712.97|5313.06|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5712.97||||5712.97|1885.28|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5712.97||||5712.97|2856.49|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5712.97||||5712.97|0|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|MULTIPLAN [1680]|HMA [168003]|5712.97||||5712.97|1999.54|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|MULTIPLAN [1680]|IHC HS [168011]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5712.97||||5712.97|0|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|Self-pay|Self-pay|5712.97||||5712.97|1713.89|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5712.97||||5712.97|1199.72|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|TRUSTMARK [2030]|STARMARK [203000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5712.97||||5712.97|1457.38|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|UMR [2035]|UMR OPTIONS [203501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5712.97||||5712.97|0|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|5712.97||||5712.97|5141.67|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5712.97||||5712.97|1169.3|5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5712.97||||5712.97||5313.06|1169.3
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5712.97||||5712.97|2856.49|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|5712.97||||5712.97|1999.54|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5712.97||||5712.97|0|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5712.97||||5712.97|0|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5712.97||||5712.97|0|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5712.97||||5712.97|0|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5712.97||||5712.97|2456.58|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5712.97||||5712.97|0|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5712.97||||5712.97|2856.49|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5712.97||||5712.97|3713.43|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5712.97||||5712.97|2799.36|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5712.97||||5712.97|1169.3|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GEHA [1415]|GEHA [141500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5712.97||||5712.97|1999.54|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5712.97||||5712.97|2456.58|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5712.97||||5712.97|5313.06|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5712.97||||5712.97|1885.28|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5712.97||||5712.97|2856.49|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5712.97||||5712.97|0|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MULTIPLAN [1680]|HMA [168003]|5712.97||||5712.97|1999.54|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MULTIPLAN [1680]|IHC HS [168011]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5712.97||||5712.97|0|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|Self-pay|Self-pay|5712.97||||5712.97|1713.89|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5712.97||||5712.97|1199.72|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRUSTMARK [2030]|STARMARK [203000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5712.97||||5712.97|1457.38|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR OPTIONS [203501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5712.97||||5712.97|0|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|5712.97||||5712.97|5141.67|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5712.97||||5712.97|1169.3|5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5712.97||||5712.97||5313.06|1169.3
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5712.97||||5712.97|2856.49|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|5712.97||||5712.97|1999.54|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5712.97||||5712.97|0|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5712.97||||5712.97|0|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5712.97||||5712.97|0|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5712.97||||5712.97|0|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5712.97||||5712.97|2456.58|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5712.97||||5712.97|0|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5712.97||||5712.97|2856.49|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5712.97||||5712.97|3713.43|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5712.97||||5712.97|2799.36|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5712.97||||5712.97|1169.3|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GEHA [1415]|GEHA [141500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5712.97||||5712.97|1999.54|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5712.97||||5712.97|2456.58|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5712.97||||5712.97|5313.06|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5712.97||||5712.97|1885.28|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5712.97||||5712.97|2856.49|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5712.97||||5712.97|0|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MULTIPLAN [1680]|HMA [168003]|5712.97||||5712.97|1999.54|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MULTIPLAN [1680]|IHC HS [168011]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5712.97||||5712.97|0|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|Self-pay|Self-pay|5712.97||||5712.97|1713.89|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5712.97||||5712.97|1199.72|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRUSTMARK [2030]|STARMARK [203000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5712.97||||5712.97|1457.38|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR OPTIONS [203501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5712.97||||5712.97|0|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|5712.97||||5712.97|5141.67|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5712.97||||5712.97|1169.3|5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5712.97||||5712.97||5313.06|1169.3
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5712.97||||5712.97|2856.49|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|5712.97||||5712.97|1999.54|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5712.97||||5712.97|0|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5712.97||||5712.97|0|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5712.97||||5712.97|0|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5712.97||||5712.97|0|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5712.97||||5712.97|2456.58|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5712.97||||5712.97|0|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5712.97||||5712.97|2856.49|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5712.97||||5712.97|3713.43|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5712.97||||5712.97|2799.36|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5712.97||||5712.97|1169.3|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GEHA [1415]|GEHA [141500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5712.97||||5712.97|1999.54|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5712.97||||5712.97|2456.58|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5712.97||||5712.97|5313.06|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5712.97||||5712.97|1885.28|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5712.97||||5712.97|2856.49|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5712.97||||5712.97|0|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MULTIPLAN [1680]|HMA [168003]|5712.97||||5712.97|1999.54|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MULTIPLAN [1680]|IHC HS [168011]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5712.97||||5712.97|0|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|Self-pay|Self-pay|5712.97||||5712.97|1713.89|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5712.97||||5712.97|1199.72|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|TRUSTMARK [2030]|STARMARK [203000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5712.97||||5712.97|1457.38|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UMR [2035]|UMR OPTIONS [203501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5712.97||||5712.97|0|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|5712.97||||5712.97|5141.67|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5712.97||||5712.97|1169.3|5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5712.97||||5712.97||5313.06|1169.3
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5712.97||||5712.97|2856.49|5313.06|1169.3
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]|489.03||||489.03|440.13|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|489.03||||489.03||3666.92|102.7
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 ACO WILCO [101532]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|COVENTRY HEALTHCARE [101502]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|489.03||||489.03|0|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|489.03||||489.03|0|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|489.03||||489.03||3666.92|102.7
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]|BCBS TRAD/HMO/PPO/POS NM [115513]|489.03||||489.03|0|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|489.03||||489.03|0|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|489.03||||489.03|210.28|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|489.03||||489.03|0|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|489.03||||489.03|244.52|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|489.03||||489.03|440.13|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|489.03||||489.03|317.87|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|489.03||||489.03||3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|489.03||||489.03||3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORESOURCE [1315]|CORESOURCE [131500]|489.03||||489.03|440.13|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|489.03||||489.03|239.63|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|489.03||||489.03|440.13|3666.92|102.7
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]|EMBLEM HEALTH [243001]|489.03||||489.03|440.13|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|489.03||||489.03|440.13|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|489.03||||489.03|3666.92|3666.92|102.7
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]|QUALCHOICE [137513]|489.03||||489.03|440.13|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|489.03||||489.03|440.13|3666.92|102.7
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 [141500]|489.03||||489.03|440.13|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|210.28|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|489.03||||489.03|440.13|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|489.03||||489.03|454.8|3666.92|102.7
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 CHOICECARE [214003]|489.03||||489.03|161.38|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|489.03||||489.03||3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|489.03||||489.03|440.13|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|244.52|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|489.03||||489.03|0|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|489.03||||489.03||3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|489.03||||489.03||3666.92|102.7
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]|HMA [168003]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|489.03||||489.03|440.13|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|489.03||||489.03||3666.92|102.7
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|489.03||||489.03|146.71|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|489.03||||489.03|102.7|3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|489.03||||489.03||3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|489.03||||489.03||3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|124.75|3666.92|102.7
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 OPTIONS [203501]|489.03||||489.03|440.13|3666.92|102.7
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 CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|GOLDEN RULE [206003]|489.03||||489.03|440.13|3666.92|102.7
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]|THE EMPIRE PLAN [206029]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|3666.92|3666.92|102.7
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]|DEPARTMENT OF LABOR (WC) [212507]|489.03||||489.03||3666.92|102.7
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|489.03||||489.03|244.52|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|489.03||||489.03||3666.92|102.7
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 ACO WILCO [101532]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|COVENTRY HEALTHCARE [101502]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|489.03||||489.03|0|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|489.03||||489.03|0|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|489.03||||489.03||3666.92|102.7
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]|BCBS TRAD/HMO/PPO/POS NM [115513]|489.03||||489.03|0|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|489.03||||489.03|0|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|489.03||||489.03|210.28|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|489.03||||489.03|0|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|489.03||||489.03|244.52|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|489.03||||489.03|440.13|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|489.03||||489.03|317.87|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|489.03||||489.03||3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|489.03||||489.03||3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORESOURCE [1315]|CORESOURCE [131500]|489.03||||489.03|440.13|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|489.03||||489.03|239.63|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|489.03||||489.03|440.13|3666.92|102.7
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]|EMBLEM HEALTH [243001]|489.03||||489.03|440.13|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|489.03||||489.03|440.13|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|489.03||||489.03|3666.92|3666.92|102.7
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]|QUALCHOICE [137513]|489.03||||489.03|440.13|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|489.03||||489.03|440.13|3666.92|102.7
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 [141500]|489.03||||489.03|440.13|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|210.28|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|489.03||||489.03|440.13|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|489.03||||489.03|454.8|3666.92|102.7
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 CHOICECARE [214003]|489.03||||489.03|161.38|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|489.03||||489.03||3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|489.03||||489.03|440.13|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|244.52|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|489.03||||489.03|0|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|489.03||||489.03||3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|489.03||||489.03||3666.92|102.7
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]|HMA [168003]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|489.03||||489.03|440.13|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|489.03||||489.03||3666.92|102.7
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|489.03||||489.03|146.71|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|489.03||||489.03|102.7|3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|489.03||||489.03||3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|489.03||||489.03||3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|124.75|3666.92|102.7
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 OPTIONS [203501]|489.03||||489.03|440.13|3666.92|102.7
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 CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|GOLDEN RULE [206003]|489.03||||489.03|440.13|3666.92|102.7
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]|THE EMPIRE PLAN [206029]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|3666.92|3666.92|102.7
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]|DEPARTMENT OF LABOR (WC) [212507]|489.03||||489.03||3666.92|102.7
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|489.03||||489.03|244.52|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|489.03||||489.03||3666.92|102.7
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 ACO WILCO [101532]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|COVENTRY HEALTHCARE [101502]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|489.03||||489.03|0|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|489.03||||489.03|0|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|489.03||||489.03||3666.92|102.7
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]|BCBS TRAD/HMO/PPO/POS NM [115513]|489.03||||489.03|0|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|489.03||||489.03|0|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|489.03||||489.03|210.28|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|489.03||||489.03|0|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|489.03||||489.03|244.52|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|489.03||||489.03|440.13|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|489.03||||489.03|317.87|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|489.03||||489.03||3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|489.03||||489.03||3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORESOURCE [1315]|CORESOURCE [131500]|489.03||||489.03|440.13|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|489.03||||489.03|239.63|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|489.03||||489.03|440.13|3666.92|102.7
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]|EMBLEM HEALTH [243001]|489.03||||489.03|440.13|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|489.03||||489.03|440.13|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|489.03||||489.03|3666.92|3666.92|102.7
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]|QUALCHOICE [137513]|489.03||||489.03|440.13|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|489.03||||489.03|440.13|3666.92|102.7
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 [141500]|489.03||||489.03|440.13|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|210.28|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|489.03||||489.03|440.13|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|489.03||||489.03|454.8|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|489.03||||489.03|161.38|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|489.03||||489.03||3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|489.03||||489.03|440.13|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|244.52|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|489.03||||489.03|0|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|489.03||||489.03||3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|489.03||||489.03||3666.92|102.7
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]|HMA [168003]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|489.03||||489.03|440.13|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|489.03||||489.03||3666.92|102.7
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|489.03||||489.03|146.71|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|489.03||||489.03|102.7|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|489.03||||489.03||3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|489.03||||489.03||3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|124.75|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR OPTIONS [203501]|489.03||||489.03|440.13|3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|GOLDEN RULE [206003]|489.03||||489.03|440.13|3666.92|102.7
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]|THE EMPIRE PLAN [206029]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|3666.92|3666.92|102.7
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]|DEPARTMENT OF LABOR (WC) [212507]|489.03||||489.03||3666.92|102.7
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|489.03||||489.03|244.52|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|489.03||||489.03||3666.92|102.7
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 ACO WILCO [101532]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|COVENTRY HEALTHCARE [101502]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|489.03||||489.03|0|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|489.03||||489.03|0|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|489.03||||489.03||3666.92|102.7
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]|BCBS TRAD/HMO/PPO/POS NM [115513]|489.03||||489.03|0|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|489.03||||489.03|0|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|489.03||||489.03|210.28|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|489.03||||489.03|0|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|489.03||||489.03|244.52|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|489.03||||489.03|440.13|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|489.03||||489.03|317.87|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|489.03||||489.03||3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|489.03||||489.03||3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORESOURCE [1315]|CORESOURCE [131500]|489.03||||489.03|440.13|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|489.03||||489.03|239.63|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|489.03||||489.03|440.13|3666.92|102.7
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]|EMBLEM HEALTH [243001]|489.03||||489.03|440.13|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|489.03||||489.03|440.13|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|489.03||||489.03|3666.92|3666.92|102.7
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]|QUALCHOICE [137513]|489.03||||489.03|440.13|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|489.03||||489.03|440.13|3666.92|102.7
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 [141500]|489.03||||489.03|440.13|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|210.28|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|489.03||||489.03|440.13|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|489.03||||489.03|454.8|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|489.03||||489.03|161.38|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|489.03||||489.03||3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|489.03||||489.03|440.13|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|244.52|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|489.03||||489.03|0|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|489.03||||489.03||3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|489.03||||489.03||3666.92|102.7
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]|HMA [168003]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|489.03||||489.03|440.13|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|489.03||||489.03||3666.92|102.7
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|489.03||||489.03|146.71|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|489.03||||489.03|102.7|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|489.03||||489.03||3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|489.03||||489.03||3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|124.75|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR OPTIONS [203501]|489.03||||489.03|440.13|3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|GOLDEN RULE [206003]|489.03||||489.03|440.13|3666.92|102.7
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]|THE EMPIRE PLAN [206029]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|3666.92|3666.92|102.7
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]|DEPARTMENT OF LABOR (WC) [212507]|489.03||||489.03||3666.92|102.7
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|489.03||||489.03|244.52|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|489.03||||489.03||3666.92|102.7
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 ACO WILCO [101532]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|COVENTRY HEALTHCARE [101502]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|489.03||||489.03|0|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|489.03||||489.03|0|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|489.03||||489.03||3666.92|102.7
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]|BCBS TRAD/HMO/PPO/POS NM [115513]|489.03||||489.03|0|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|489.03||||489.03|0|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|489.03||||489.03|210.28|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|489.03||||489.03|0|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|489.03||||489.03|244.52|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|489.03||||489.03|440.13|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|489.03||||489.03|317.87|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|489.03||||489.03||3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|489.03||||489.03||3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORESOURCE [1315]|CORESOURCE [131500]|489.03||||489.03|440.13|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|489.03||||489.03|239.63|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|489.03||||489.03|440.13|3666.92|102.7
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]|EMBLEM HEALTH [243001]|489.03||||489.03|440.13|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|489.03||||489.03|440.13|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|489.03||||489.03|3666.92|3666.92|102.7
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]|QUALCHOICE [137513]|489.03||||489.03|440.13|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|489.03||||489.03|440.13|3666.92|102.7
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 [141500]|489.03||||489.03|440.13|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|210.28|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|489.03||||489.03|440.13|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|489.03||||489.03|454.8|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|489.03||||489.03|161.38|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|489.03||||489.03||3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|489.03||||489.03|440.13|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|244.52|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|489.03||||489.03|0|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|489.03||||489.03||3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|489.03||||489.03||3666.92|102.7
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]|HMA [168003]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|489.03||||489.03|440.13|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|489.03||||489.03||3666.92|102.7
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|489.03||||489.03|146.71|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|489.03||||489.03|102.7|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|489.03||||489.03||3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|489.03||||489.03||3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|124.75|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UMR [2035]|UMR OPTIONS [203501]|489.03||||489.03|440.13|3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|GOLDEN RULE [206003]|489.03||||489.03|440.13|3666.92|102.7
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]|THE EMPIRE PLAN [206029]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|3666.92|3666.92|102.7
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]|DEPARTMENT OF LABOR (WC) [212507]|489.03||||489.03||3666.92|102.7
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|489.03||||489.03|244.52|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|489.03||||489.03||3666.92|102.7
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 ACO WILCO [101532]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|COVENTRY HEALTHCARE [101502]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|489.03||||489.03|0|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|489.03||||489.03|0|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|489.03||||489.03||3666.92|102.7
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]|BCBS TRAD/HMO/PPO/POS NM [115513]|489.03||||489.03|0|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|489.03||||489.03|0|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|489.03||||489.03|210.28|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|489.03||||489.03|0|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|489.03||||489.03|244.52|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|489.03||||489.03|440.13|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|489.03||||489.03|317.87|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|489.03||||489.03||3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|489.03||||489.03||3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORESOURCE [1315]|CORESOURCE [131500]|489.03||||489.03|440.13|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|489.03||||489.03|239.63|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|489.03||||489.03|440.13|3666.92|102.7
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]|EMBLEM HEALTH [243001]|489.03||||489.03|440.13|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|489.03||||489.03|440.13|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|489.03||||489.03|3666.92|3666.92|102.7
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]|QUALCHOICE [137513]|489.03||||489.03|440.13|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|489.03||||489.03|440.13|3666.92|102.7
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 [141500]|489.03||||489.03|440.13|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|210.28|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|489.03||||489.03|440.13|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|489.03||||489.03|454.8|3666.92|102.7
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 CHOICECARE [214003]|489.03||||489.03|161.38|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|489.03||||489.03||3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|489.03||||489.03|440.13|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|244.52|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|489.03||||489.03|0|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|489.03||||489.03||3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|489.03||||489.03||3666.92|102.7
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]|HMA [168003]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|489.03||||489.03|440.13|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|489.03||||489.03||3666.92|102.7
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|489.03||||489.03|146.71|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|489.03||||489.03|102.7|3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|489.03||||489.03||3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|489.03||||489.03||3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|124.75|3666.92|102.7
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 OPTIONS [203501]|489.03||||489.03|440.13|3666.92|102.7
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 CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|GOLDEN RULE [206003]|489.03||||489.03|440.13|3666.92|102.7
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]|THE EMPIRE PLAN [206029]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|3666.92|3666.92|102.7
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]|DEPARTMENT OF LABOR (WC) [212507]|489.03||||489.03||3666.92|102.7
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|489.03||||489.03|244.52|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|489.03||||489.03||3666.92|102.7
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 ACO WILCO [101532]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|COVENTRY HEALTHCARE [101502]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|489.03||||489.03|0|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|489.03||||489.03|0|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|489.03||||489.03||3666.92|102.7
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]|BCBS TRAD/HMO/PPO/POS NM [115513]|489.03||||489.03|0|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|489.03||||489.03|0|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|489.03||||489.03|210.28|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|489.03||||489.03|0|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|489.03||||489.03|244.52|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|489.03||||489.03|440.13|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|489.03||||489.03|317.87|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|489.03||||489.03||3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|489.03||||489.03||3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORESOURCE [1315]|CORESOURCE [131500]|489.03||||489.03|440.13|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|CORVEL CORP [2235]|CORVEL CORP [223500]|489.03||||489.03|239.63|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|489.03||||489.03|440.13|3666.92|102.7
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]|EMBLEM HEALTH [243001]|489.03||||489.03|440.13|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|489.03||||489.03|440.13|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|489.03||||489.03|3666.92|3666.92|102.7
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]|QUALCHOICE [137513]|489.03||||489.03|440.13|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|489.03||||489.03|440.13|3666.92|102.7
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 [141500]|489.03||||489.03|440.13|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|210.28|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|489.03||||489.03|440.13|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|489.03||||489.03|454.8|3666.92|102.7
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 CHOICECARE [214003]|489.03||||489.03|161.38|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|489.03||||489.03||3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|489.03||||489.03|440.13|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|244.52|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|489.03||||489.03|0|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|489.03||||489.03||3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|489.03||||489.03||3666.92|102.7
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]|HMA [168003]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|489.03||||489.03|440.13|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|489.03||||489.03||3666.92|102.7
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|489.03||||489.03|146.71|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|489.03||||489.03|102.7|3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|489.03||||489.03||3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|489.03||||489.03||3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03|124.75|3666.92|102.7
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 OPTIONS [203501]|489.03||||489.03|440.13|3666.92|102.7
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 CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|489.03||||489.03|0|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|GOLDEN RULE [206003]|489.03||||489.03|440.13|3666.92|102.7
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]|THE EMPIRE PLAN [206029]|489.03||||489.03|440.13|3666.92|102.7
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]|489.03||||489.03||3666.92|102.7
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]|489.03||||489.03|3666.92|3666.92|102.7
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]|DEPARTMENT OF LABOR (WC) [212507]|489.03||||489.03||3666.92|102.7
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|489.03||||489.03|244.52|3666.92|102.7
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|2296.13||||2296.13|803.65|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2296.13||||2296.13|0|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2296.13||||2296.13|0|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2296.13||||2296.13|0|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2296.13||||2296.13|0|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2296.13||||2296.13|987.34|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2296.13||||2296.13|0|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2296.13||||2296.13|1148.07|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2296.13||||2296.13|1492.49|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|CORESOURCE [1315]|CORESOURCE [131500]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2296.13||||2296.13|1125.11|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2296.13||||2296.13|1169.3|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|GEHA [1415]|GEHA [141500]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2296.13||||2296.13|803.65|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|HEALTHNET [1495]|HEALTHNET [149500]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2296.13||||2296.13|987.34|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2296.13||||2296.13|2135.4|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2296.13||||2296.13|757.72|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2296.13||||2296.13|1148.07|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2296.13||||2296.13|0|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|MULTIPLAN [1680]|HMA [168003]|2296.13||||2296.13|803.65|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|MULTIPLAN [1680]|IHC HS [168011]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2296.13||||2296.13|0|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|Self-pay|Self-pay|2296.13||||2296.13|688.84|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2296.13||||2296.13|482.19|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|TRUSTMARK [2030]|STARMARK [203000]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2296.13||||2296.13|585.74|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|UMR [2035]|UMR OPTIONS [203501]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2296.13||||2296.13|0|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|2296.13||||2296.13|2066.52|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2296.13||||2296.13|1169.3|2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2296.13||||2296.13||2135.4|482.19
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2296.13||||2296.13|1148.07|2135.4|482.19
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA ACO WILCO [101532]|2307.08||||2307.08|807.48|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2307.08||||2307.08|0|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2307.08||||2307.08|0|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2307.08||||2307.08|0|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2307.08||||2307.08|0|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2307.08||||2307.08|992.04|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2307.08||||2307.08|0|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2307.08||||2307.08|1153.54|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2307.08||||2307.08|1499.6|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORESOURCE [1315]|CORESOURCE [131500]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2307.08||||2307.08|1130.47|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2307.08||||2307.08|1169.3|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GEHA [1415]|GEHA [141500]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2307.08||||2307.08|807.48|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHNET [1495]|HEALTHNET [149500]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2307.08||||2307.08|992.04|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2307.08||||2307.08|2145.58|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2307.08||||2307.08|761.34|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2307.08||||2307.08|1153.54|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2307.08||||2307.08|0|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|HMA [168003]|2307.08||||2307.08|807.48|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|IHC HS [168011]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2307.08||||2307.08|0|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|Self-pay|Self-pay|2307.08||||2307.08|692.12|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2307.08||||2307.08|484.49|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|STARMARK [203000]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2307.08||||2307.08|588.54|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR OPTIONS [203501]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2307.08||||2307.08|0|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|2307.08||||2307.08|2076.37|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2307.08||||2307.08|1169.3|2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2307.08||||2307.08||2145.58|484.49
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2307.08||||2307.08|1153.54|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA ACO WILCO [101532]|2307.08||||2307.08|807.48|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2307.08||||2307.08|0|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2307.08||||2307.08|0|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2307.08||||2307.08|0|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2307.08||||2307.08|0|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2307.08||||2307.08|992.04|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2307.08||||2307.08|0|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2307.08||||2307.08|1153.54|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2307.08||||2307.08|1499.6|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORESOURCE [1315]|CORESOURCE [131500]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2307.08||||2307.08|1130.47|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2307.08||||2307.08|1169.3|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GEHA [1415]|GEHA [141500]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2307.08||||2307.08|807.48|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHNET [1495]|HEALTHNET [149500]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2307.08||||2307.08|992.04|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2307.08||||2307.08|2145.58|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2307.08||||2307.08|761.34|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2307.08||||2307.08|1153.54|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2307.08||||2307.08|0|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|HMA [168003]|2307.08||||2307.08|807.48|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|IHC HS [168011]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2307.08||||2307.08|0|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|Self-pay|Self-pay|2307.08||||2307.08|692.12|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2307.08||||2307.08|484.49|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|STARMARK [203000]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2307.08||||2307.08|588.54|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR OPTIONS [203501]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2307.08||||2307.08|0|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|2307.08||||2307.08|2076.37|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2307.08||||2307.08|1169.3|2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2307.08||||2307.08||2145.58|484.49
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2307.08||||2307.08|1153.54|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA ACO WILCO [101532]|2307.08||||2307.08|807.48|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2307.08||||2307.08|0|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2307.08||||2307.08|0|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2307.08||||2307.08|0|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2307.08||||2307.08|0|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2307.08||||2307.08|992.04|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2307.08||||2307.08|0|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2307.08||||2307.08|1153.54|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2307.08||||2307.08|1499.6|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORESOURCE [1315]|CORESOURCE [131500]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2307.08||||2307.08|1130.47|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2307.08||||2307.08|1169.3|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GEHA [1415]|GEHA [141500]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2307.08||||2307.08|807.48|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHNET [1495]|HEALTHNET [149500]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2307.08||||2307.08|992.04|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2307.08||||2307.08|2145.58|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2307.08||||2307.08|761.34|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2307.08||||2307.08|1153.54|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2307.08||||2307.08|0|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|HMA [168003]|2307.08||||2307.08|807.48|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|IHC HS [168011]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2307.08||||2307.08|0|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|Self-pay|Self-pay|2307.08||||2307.08|692.12|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2307.08||||2307.08|484.49|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|STARMARK [203000]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2307.08||||2307.08|588.54|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR OPTIONS [203501]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2307.08||||2307.08|0|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|2307.08||||2307.08|2076.37|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2307.08||||2307.08|1169.3|2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2307.08||||2307.08||2145.58|484.49
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2307.08||||2307.08|1153.54|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA ACO WILCO [101532]|2307.08||||2307.08|807.48|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2307.08||||2307.08|0|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2307.08||||2307.08|0|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2307.08||||2307.08|0|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2307.08||||2307.08|0|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2307.08||||2307.08|992.04|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2307.08||||2307.08|0|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2307.08||||2307.08|1153.54|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2307.08||||2307.08|1499.6|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORESOURCE [1315]|CORESOURCE [131500]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2307.08||||2307.08|1130.47|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2307.08||||2307.08|1169.3|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GEHA [1415]|GEHA [141500]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2307.08||||2307.08|807.48|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHNET [1495]|HEALTHNET [149500]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2307.08||||2307.08|992.04|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2307.08||||2307.08|2145.58|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2307.08||||2307.08|761.34|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2307.08||||2307.08|1153.54|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2307.08||||2307.08|0|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|HMA [168003]|2307.08||||2307.08|807.48|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|IHC HS [168011]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2307.08||||2307.08|0|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|Self-pay|Self-pay|2307.08||||2307.08|692.12|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2307.08||||2307.08|484.49|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|STARMARK [203000]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2307.08||||2307.08|588.54|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR OPTIONS [203501]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2307.08||||2307.08|0|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|2307.08||||2307.08|2076.37|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2307.08||||2307.08|1169.3|2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2307.08||||2307.08||2145.58|484.49
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2307.08||||2307.08|1153.54|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA ACO WILCO [101532]|2307.08||||2307.08|807.48|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2307.08||||2307.08|0|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2307.08||||2307.08|0|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2307.08||||2307.08|0|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2307.08||||2307.08|0|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2307.08||||2307.08|992.04|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2307.08||||2307.08|0|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2307.08||||2307.08|1153.54|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2307.08||||2307.08|1499.6|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORESOURCE [1315]|CORESOURCE [131500]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2307.08||||2307.08|1130.47|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2307.08||||2307.08|1169.3|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GEHA [1415]|GEHA [141500]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2307.08||||2307.08|807.48|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHNET [1495]|HEALTHNET [149500]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2307.08||||2307.08|992.04|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2307.08||||2307.08|2145.58|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2307.08||||2307.08|761.34|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2307.08||||2307.08|1153.54|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2307.08||||2307.08|0|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|HMA [168003]|2307.08||||2307.08|807.48|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|IHC HS [168011]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2307.08||||2307.08|0|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|Self-pay|Self-pay|2307.08||||2307.08|692.12|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2307.08||||2307.08|484.49|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|STARMARK [203000]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2307.08||||2307.08|588.54|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR OPTIONS [203501]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2307.08||||2307.08|0|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|2307.08||||2307.08|2076.37|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2307.08||||2307.08|1169.3|2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2307.08||||2307.08||2145.58|484.49
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2307.08||||2307.08|1153.54|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA ACO WILCO [101532]|2307.08||||2307.08|807.48|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2307.08||||2307.08|0|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2307.08||||2307.08|0|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2307.08||||2307.08|0|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2307.08||||2307.08|0|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2307.08||||2307.08|992.04|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2307.08||||2307.08|0|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2307.08||||2307.08|1153.54|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2307.08||||2307.08|1499.6|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORESOURCE [1315]|CORESOURCE [131500]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2307.08||||2307.08|1130.47|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2307.08||||2307.08|1169.3|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GEHA [1415]|GEHA [141500]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2307.08||||2307.08|807.48|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHNET [1495]|HEALTHNET [149500]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2307.08||||2307.08|992.04|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2307.08||||2307.08|2145.58|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2307.08||||2307.08|761.34|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2307.08||||2307.08|1153.54|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2307.08||||2307.08|0|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|HMA [168003]|2307.08||||2307.08|807.48|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|IHC HS [168011]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2307.08||||2307.08|0|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|Self-pay|Self-pay|2307.08||||2307.08|692.12|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2307.08||||2307.08|484.49|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|STARMARK [203000]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2307.08||||2307.08|588.54|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR OPTIONS [203501]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2307.08||||2307.08|0|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|2307.08||||2307.08|2076.37|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2307.08||||2307.08|1169.3|2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2307.08||||2307.08||2145.58|484.49
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2307.08||||2307.08|1153.54|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA ACO WILCO [101532]|2307.08||||2307.08|807.48|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2307.08||||2307.08|0|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2307.08||||2307.08|0|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|2307.08||||2307.08|0|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2307.08||||2307.08|0|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2307.08||||2307.08|992.04|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|2307.08||||2307.08|0|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|2307.08||||2307.08|1153.54|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2307.08||||2307.08|1499.6|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORESOURCE [1315]|CORESOURCE [131500]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|CORVEL CORP [2235]|CORVEL CORP [223500]|2307.08||||2307.08|1130.47|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|2307.08||||2307.08|1169.3|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GEHA [1415]|GEHA [141500]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|2307.08||||2307.08|807.48|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHNET [1495]|HEALTHNET [149500]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2307.08||||2307.08|992.04|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|2307.08||||2307.08|2145.58|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2307.08||||2307.08|761.34|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2307.08||||2307.08|1153.54|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2307.08||||2307.08|0|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|HMA [168003]|2307.08||||2307.08|807.48|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MULTIPLAN [1680]|IHC HS [168011]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|2307.08||||2307.08|0|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|Self-pay|Self-pay|2307.08||||2307.08|692.12|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2307.08||||2307.08|484.49|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|TRUSTMARK [2030]|STARMARK [203000]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2307.08||||2307.08|588.54|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UMR [2035]|UMR OPTIONS [203501]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2307.08||||2307.08|0|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|2307.08||||2307.08|2076.37|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|2307.08||||2307.08|1169.3|2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|2307.08||||2307.08||2145.58|484.49
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|2307.08||||2307.08|1153.54|2145.58|484.49
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|GEHA [1415]|GEHA [141500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|29||||29|9.57|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|Self-pay|Self-pay|29||||29|8.7|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|7.4|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|6.09
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|AETNA [1015]|AETNA ACO WILCO [101532]|11.07||||11.07|0|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.07||||11.07|0|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.07||||11.07|0|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|11.07||||11.07|0|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.07||||11.07|0|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.07||||11.07|4.76|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|11.07||||11.07|0|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|11.07||||11.07|5.54|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.07||||11.07|7.2|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|CORESOURCE [1315]|CORESOURCE [131500]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|11.07||||11.07|0|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|11.07||||11.07|4.1|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|GEHA [1415]|GEHA [141500]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|HEALTHNET [1495]|HEALTHNET [149500]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.07||||11.07|4.76|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|11.07||||11.07|10.3|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|11.07||||11.07|3.65|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.07||||11.07|0|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.07||||11.07|0|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|MULTIPLAN [1680]|HMA [168003]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|MULTIPLAN [1680]|IHC HS [168011]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|11.07||||11.07|0|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|Self-pay|Self-pay|11.07||||11.07|3.32|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.07||||11.07|2.33|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|TRUSTMARK [2030]|STARMARK [203000]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.07||||11.07|2.82|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|UMR [2035]|UMR OPTIONS [203501]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.07||||11.07|0|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|11.07||||11.07|9.97|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|11.07||||11.07|4.1|10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|11.07||||11.07||10.3|2.33
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|11.07||||11.07|5.54|10.3|2.33
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|4420.5||||4420.5|1547.18|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4420.5||||4420.5|0|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4420.5||||4420.5|0|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4420.5||||4420.5|0|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4420.5||||4420.5|0|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4420.5||||4420.5|1900.82|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4420.5||||4420.5|0|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4420.5||||4420.5|2210.25|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4420.5||||4420.5|2873.33|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4420.5||||4420.5|2166.05|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4420.5||||4420.5|3666.92|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|GEHA [1415]|GEHA [141500]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4420.5||||4420.5|1547.18|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4420.5||||4420.5|1900.82|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4420.5||||4420.5|4111.07|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4420.5||||4420.5|1458.77|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4420.5||||4420.5|2210.25|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4420.5||||4420.5|0|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|MULTIPLAN [1680]|HMA [168003]|4420.5||||4420.5|1547.18|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|MULTIPLAN [1680]|IHC HS [168011]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4420.5||||4420.5|0|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|Self-pay|Self-pay|4420.5||||4420.5|1326.15|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4420.5||||4420.5|928.31|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|TRUSTMARK [2030]|STARMARK [203000]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4420.5||||4420.5|1127.67|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|UMR [2035]|UMR OPTIONS [203501]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4420.5||||4420.5|0|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|4420.5||||4420.5|3978.45|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4420.5||||4420.5|3666.92|4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4420.5||||4420.5||4111.07|928.31
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4420.5||||4420.5|2210.25|4111.07|928.31
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|10||||10|3.3|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|2.55|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|10||||10|9|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1922.29||||1922.29|672.8|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1922.29||||1922.29|1730.06|1787.73|403.68
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]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1922.29||||1922.29|0|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1922.29||||1922.29|0|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1922.29||||1922.29|0|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1922.29||||1922.29|0|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1922.29||||1922.29|826.58|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1922.29||||1922.29|0|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1922.29||||1922.29|961.14|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1922.29||||1922.29|1249.49|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|CORESOURCE [1315]|CORESOURCE [131500]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1922.29||||1922.29|941.92|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1922.29||||1922.29|1169.3|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|GEHA [1415]|GEHA [141500]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1922.29||||1922.29|672.8|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HEALTHNET [1495]|HEALTHNET [149500]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1922.29||||1922.29|826.58|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1922.29||||1922.29|1787.73|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1922.29||||1922.29|634.35|1787.73|403.68
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]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1922.29||||1922.29||1787.73|403.68
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]|1922.29||||1922.29|961.14|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1922.29||||1922.29|0|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MULTIPLAN [1680]|HMA [168003]|1922.29||||1922.29|672.8|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MULTIPLAN [1680]|IHC HS [168011]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1922.29||||1922.29|1730.06|1787.73|403.68
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]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1922.29||||1922.29|0|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|Self-pay|Self-pay|1922.29||||1922.29|576.69|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1922.29||||1922.29|403.68|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|TRUSTMARK [2030]|STARMARK [203000]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1922.29||||1922.29|490.38|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UMR [2035]|UMR OPTIONS [203501]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1922.29||||1922.29|0|1787.73|403.68
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]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1922.29||||1922.29|1730.06|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1922.29||||1922.29|1169.3|1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1922.29||||1922.29||1787.73|403.68
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1922.29||||1922.29|961.14|1787.73|403.68
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AETNA [1015]|AETNA ACO WILCO [101532]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|512.93||||512.93|220.56|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|512.93||||512.93|256.47|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|512.93||||512.93|333.4|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CORESOURCE [1315]|CORESOURCE [131500]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|512.93||||512.93|189.78|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|GEHA [1415]|GEHA [141500]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HEALTHNET [1495]|HEALTHNET [149500]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|512.93||||512.93|220.56|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|512.93||||512.93|477.02|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|512.93||||512.93|169.27|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MULTIPLAN [1680]|HMA [168003]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MULTIPLAN [1680]|IHC HS [168011]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|Self-pay|Self-pay|512.93||||512.93|153.88|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|512.93||||512.93|107.72|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|TRUSTMARK [2030]|STARMARK [203000]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|512.93||||512.93|130.85|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UMR [2035]|UMR OPTIONS [203501]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|512.93||||512.93|0|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|512.93||||512.93|461.64|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|512.93||||512.93|189.78|477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|512.93||||512.93||477.02|107.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|512.93||||512.93|256.47|477.02|107.72
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AETNA [1015]|AETNA ACO WILCO [101532]|1399.83||||1399.83|0|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1399.83||||1399.83|1259.84|1301.84|293.96
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]|1399.83||||1399.83|1259.84|1301.84|293.96
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]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1399.83||||1399.83|0|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1399.83||||1399.83|0|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1399.83||||1399.83|0|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1399.83||||1399.83|0|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1399.83||||1399.83|601.92|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1399.83||||1399.83|0|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1399.83||||1399.83|699.91|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1399.83||||1399.83|909.89|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|CORESOURCE [1315]|CORESOURCE [131500]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1399.83||||1399.83|685.91|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1399.83||||1399.83|1169.3|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|GEHA [1415]|GEHA [141500]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HEALTHNET [1495]|HEALTHNET [149500]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1399.83||||1399.83|601.92|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1399.83||||1399.83|1301.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1399.83||||1399.83|461.94|1301.84|293.96
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]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1399.83||||1399.83||1301.84|293.96
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]|1399.83||||1399.83||1301.84|293.96
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]|1399.83||||1399.83|699.91|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1399.83||||1399.83|0|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MULTIPLAN [1680]|HMA [168003]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|MULTIPLAN [1680]|IHC HS [168011]|1399.83||||1399.83|1259.84|1301.84|293.96
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]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1399.83||||1399.83|1259.84|1301.84|293.96
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]|1399.83||||1399.83|1259.84|1301.84|293.96
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]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1399.83||||1399.83|0|1301.84|293.96
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]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|Self-pay|Self-pay|1399.83||||1399.83|419.95|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1399.83||||1399.83|293.96|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|TRUSTMARK [2030]|STARMARK [203000]|1399.83||||1399.83|1259.84|1301.84|293.96
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]|1399.83||||1399.83|357.1|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|UMR [2035]|UMR OPTIONS [203501]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1399.83||||1399.83|0|1301.84|293.96
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]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1399.83||||1399.83|1259.84|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1399.83||||1399.83|1259.84|1301.84|293.96
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]|1399.83||||1399.83||1301.84|293.96
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]|1399.83||||1399.83|1169.3|1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1399.83||||1399.83||1301.84|293.96
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 STANDARD OD22.2 MM HIP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1399.83||||1399.83|699.91|1301.84|293.96
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|0|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|0|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|0|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|1305.1||||1305.1|639.5|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|1169.3|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA [141500]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|561.19|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|652.55|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1|332.93|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.1||||1305.1|1174.59|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1305.1||||1305.1|1174.59|1213.74|274.07
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]|1305.1||||1305.1||1213.74|274.07
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]|1305.1||||1305.1|1169.3|1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|AETNA [1015]|AETNA ACO WILCO [101532]|104.66||||104.66|0|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104.66||||104.66|0|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104.66||||104.66|0|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|104.66||||104.66|0|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104.66||||104.66|0|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104.66||||104.66|45|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|104.66||||104.66|0|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|104.66||||104.66|52.33|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104.66||||104.66|68.03|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|CORESOURCE [1315]|CORESOURCE [131500]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|104.66||||104.66|0|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|104.66||||104.66|38.72|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|GEHA [1415]|GEHA [141500]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|HEALTHNET [1495]|HEALTHNET [149500]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104.66||||104.66|45|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|104.66||||104.66|97.33|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|104.66||||104.66|34.54|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104.66||||104.66|0|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104.66||||104.66|0|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|MULTIPLAN [1680]|HMA [168003]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|MULTIPLAN [1680]|IHC HS [168011]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|104.66||||104.66|0|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|Self-pay|Self-pay|104.66||||104.66|31.4|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104.66||||104.66|21.98|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|TRUSTMARK [2030]|STARMARK [203000]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104.66||||104.66|26.7|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|UMR [2035]|UMR OPTIONS [203501]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104.66||||104.66|0|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|104.66||||104.66|94.19|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|104.66||||104.66|38.72|97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|104.66||||104.66||97.33|21.98
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX 2-0 SH SPIRAL L14 CM 2 ARM ABSORBABLE KNOTLESS TISSUE CONTROL VIOLET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|104.66||||104.66|52.33|97.33|21.98
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|3666.92|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|27.18|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|3666.92|3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||3666.92|22.38
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|3666.92|22.38
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|499.94||||499.94|0|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|499.94||||499.94|0|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|499.94||||499.94|0|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|499.94||||499.94|0|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|499.94||||499.94|0|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|499.94||||499.94|214.97|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|499.94||||499.94|0|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|499.94||||499.94|249.97|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|499.94||||499.94|324.96|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|499.94||||499.94|244.97|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|499.94||||499.94|3666.92|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|GEHA [1415]|GEHA [141500]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|499.94||||499.94|214.97|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|499.94||||499.94|464.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|499.94||||499.94|164.98|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|499.94||||499.94|249.97|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|499.94||||499.94|0|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|MULTIPLAN [1680]|HMA [168003]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|MULTIPLAN [1680]|IHC HS [168011]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|499.94||||499.94|0|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|Self-pay|Self-pay|499.94||||499.94|149.98|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|499.94||||499.94|104.99|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|TRUSTMARK [2030]|STARMARK [203000]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|499.94||||499.94|127.53|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|UMR [2035]|UMR OPTIONS [203501]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|499.94||||499.94|0|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|499.94||||499.94|449.94|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|499.94||||499.94|3666.92|3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|499.94||||499.94||3666.92|104.99
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|499.94||||499.94|249.97|3666.92|104.99
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8266.38||||8266.38|2869.45|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|AETNA [1015]|AETNA ACO WILCO [101532]|8266.38||||8266.38|0|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8266.38||||8266.38|2869.45|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8266.38||||8266.38|2926.84|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8266.38||||8266.38|2251.5|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8266.38||||8266.38|2251.5|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8266.38||||8266.38|2869.45|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|8266.38||||8266.38|4873.32|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8266.38||||8266.38|3411.52|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8266.38||||8266.38|3554.54|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|8266.38||||8266.38|4142.42|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|8266.38||||8266.38|4133.19|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8266.38||||8266.38|5373.15|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8266.38||||8266.38|2869.45|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8266.38||||8266.38|2869.45|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|CORESOURCE [1315]|CORESOURCE [131500]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|8266.38||||8266.38|2396.98|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|8266.38||||8266.38|3058.56|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|GEHA [1415]|GEHA [141500]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|8266.38||||8266.38|2893.23|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|HEALTHNET [1495]|HEALTHNET [149500]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8266.38||||8266.38|3554.54|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|8266.38||||8266.38|7687.73|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|8266.38||||8266.38|2727.91|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8266.38||||8266.38|2869.45|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|8266.38||||8266.38|2869.45|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8266.38||||8266.38|5738.9|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8266.38||||8266.38|2869.45|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8266.38||||8266.38|3548.5|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8266.38||||8266.38|2457.29|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8266.38||||8266.38|3873.76|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8266.38||||8266.38|2926.84|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|MULTIPLAN [1680]|HMA [168003]|8266.38||||8266.38|2893.23|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|MULTIPLAN [1680]|IHC HS [168011]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|8266.38||||8266.38|2869.45|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|8266.38||||8266.38|2340.15|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8266.38||||8266.38|5738.9|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|Self-pay|Self-pay|8266.38||||8266.38|2479.91|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8266.38||||8266.38|1735.94|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8266.38||||8266.38|2869.45|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|8266.38||||8266.38|2812.06|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8266.38||||8266.38|2868.89|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|TRUSTMARK [2030]|STARMARK [203000]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8266.38||||8266.38|2108.75|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|UMR [2035]|UMR OPTIONS [203501]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8266.38||||8266.38|2340.21|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8266.38||||8266.38|2869.45|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|8266.38||||8266.38|7439.74|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8266.38||||8266.38|2869.45|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|8266.38||||8266.38|3058.56|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|8266.38||||8266.38|2869.45|7687.73|1028.87
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|10 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|8266.38||||8266.38|4133.19|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|AETNA [1015]|AETNA ACO WILCO [101532]|4899.39||||4899.39|1714.79|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4899.39||||4899.39|0|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4899.39||||4899.39|0|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4899.39||||4899.39|0|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4899.39||||4899.39|0|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4899.39||||4899.39|2106.74|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4899.39||||4899.39|0|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4899.39||||4899.39|2449.69|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4899.39||||4899.39|3184.6|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|CORESOURCE [1315]|CORESOURCE [131500]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4899.39||||4899.39|2400.7|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4899.39||||4899.39|1169.3|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|GEHA [1415]|GEHA [141500]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4899.39||||4899.39|1714.79|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|HEALTHNET [1495]|HEALTHNET [149500]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4899.39||||4899.39|2106.74|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4899.39||||4899.39|4556.43|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4899.39||||4899.39|1616.8|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4899.39||||4899.39|2449.69|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4899.39||||4899.39|0|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|MULTIPLAN [1680]|HMA [168003]|4899.39||||4899.39|1714.79|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|MULTIPLAN [1680]|IHC HS [168011]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4899.39||||4899.39|0|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|Self-pay|Self-pay|4899.39||||4899.39|1469.82|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4899.39||||4899.39|1028.87|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|TRUSTMARK [2030]|STARMARK [203000]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4899.39||||4899.39|1249.83|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|UMR [2035]|UMR OPTIONS [203501]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4899.39||||4899.39|0|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|4899.39||||4899.39|4409.45|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4899.39||||4899.39|1169.3|7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4899.39||||4899.39||7687.73|1028.87
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4899.39||||4899.39|2449.69|7687.73|1028.87
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|499.94||||499.94|0|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|499.94||||499.94|0|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|499.94||||499.94|0|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|499.94||||499.94|0|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|499.94||||499.94|0|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|499.94||||499.94|214.97|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|499.94||||499.94|0|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|499.94||||499.94|249.97|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|499.94||||499.94|324.96|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|499.94||||499.94|244.97|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|499.94||||499.94|3666.92|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|GEHA [1415]|GEHA [141500]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|499.94||||499.94|214.97|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|499.94||||499.94|464.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|499.94||||499.94|164.98|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|499.94||||499.94|249.97|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|499.94||||499.94|0|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|MULTIPLAN [1680]|HMA [168003]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|MULTIPLAN [1680]|IHC HS [168011]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|499.94||||499.94|0|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|Self-pay|Self-pay|499.94||||499.94|149.98|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|499.94||||499.94|104.99|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|TRUSTMARK [2030]|STARMARK [203000]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|499.94||||499.94|127.53|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|UMR [2035]|UMR OPTIONS [203501]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|499.94||||499.94|0|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|499.94||||499.94|449.94|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|499.94||||499.94|3666.92|3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|499.94||||499.94||3666.92|104.99
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L20 MM OD4.5 MM PERIPHERAL STERILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|499.94||||499.94|249.97|3666.92|104.99
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|AETNA [1015]|AETNA ACO WILCO [101532]|4899.39||||4899.39|1714.79|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4899.39||||4899.39|0|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4899.39||||4899.39|0|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4899.39||||4899.39|0|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4899.39||||4899.39|0|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4899.39||||4899.39|2106.74|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4899.39||||4899.39|0|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4899.39||||4899.39|2449.69|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4899.39||||4899.39|3184.6|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|CORESOURCE [1315]|CORESOURCE [131500]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|4899.39||||4899.39|2400.7|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4899.39||||4899.39|1169.3|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|GEHA [1415]|GEHA [141500]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4899.39||||4899.39|1714.79|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|HEALTHNET [1495]|HEALTHNET [149500]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4899.39||||4899.39|2106.74|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4899.39||||4899.39|4556.43|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4899.39||||4899.39|1616.8|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4899.39||||4899.39|2449.69|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4899.39||||4899.39|0|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|MULTIPLAN [1680]|HMA [168003]|4899.39||||4899.39|1714.79|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|MULTIPLAN [1680]|IHC HS [168011]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4899.39||||4899.39|0|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|Self-pay|Self-pay|4899.39||||4899.39|1469.82|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4899.39||||4899.39|1028.87|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|TRUSTMARK [2030]|STARMARK [203000]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4899.39||||4899.39|1249.83|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|UMR [2035]|UMR OPTIONS [203501]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4899.39||||4899.39|0|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|4899.39||||4899.39|4409.45|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4899.39||||4899.39|1169.3|4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4899.39||||4899.39||4556.43|1028.87
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4899.39||||4899.39|2449.69|4556.43|1028.87
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|AETNA [1015]|AETNA ACO WILCO [101532]|3999.5||||3999.5|1399.83|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3999.5||||3999.5|0|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3999.5||||3999.5|0|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3999.5||||3999.5|0|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3999.5||||3999.5|0|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3999.5||||3999.5|1719.79|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3999.5||||3999.5|0|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3999.5||||3999.5|1999.75|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3999.5||||3999.5|2599.68|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|CORESOURCE [1315]|CORESOURCE [131500]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3999.5||||3999.5|1959.76|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3999.5||||3999.5|1169.3|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|GEHA [1415]|GEHA [141500]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3999.5||||3999.5|1399.83|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|HEALTHNET [1495]|HEALTHNET [149500]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3999.5||||3999.5|1719.79|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3999.5||||3999.5|3719.54|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3999.5||||3999.5|1319.84|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3999.5||||3999.5|1999.75|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3999.5||||3999.5|0|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|MULTIPLAN [1680]|HMA [168003]|3999.5||||3999.5|1399.83|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|MULTIPLAN [1680]|IHC HS [168011]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3999.5||||3999.5|0|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|Self-pay|Self-pay|3999.5||||3999.5|1199.85|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3999.5||||3999.5|839.9|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|TRUSTMARK [2030]|STARMARK [203000]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3999.5||||3999.5|1020.27|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|UMR [2035]|UMR OPTIONS [203501]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3999.5||||3999.5|0|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|3999.5||||3999.5|3599.55|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3999.5||||3999.5|1169.3|3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3999.5||||3999.5||3719.54|839.9
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3999.5||||3999.5|1999.75|3719.54|839.9
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|521.37||||521.37|0|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|521.37||||521.37|0|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|521.37||||521.37|0|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|521.37||||521.37|0|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|521.37||||521.37|0|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|521.37||||521.37|224.19|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|521.37||||521.37|0|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|521.37||||521.37|260.68|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|521.37||||521.37|338.89|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|CORESOURCE [1315]|CORESOURCE [131500]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|521.37||||521.37|0|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|521.37||||521.37|192.91|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|GEHA [1415]|GEHA [141500]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|HEALTHNET [1495]|HEALTHNET [149500]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|521.37||||521.37|224.19|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|521.37||||521.37|484.87|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|521.37||||521.37|172.05|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|521.37||||521.37|0|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|521.37||||521.37|0|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|MULTIPLAN [1680]|HMA [168003]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|MULTIPLAN [1680]|IHC HS [168011]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|521.37||||521.37|0|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|Self-pay|Self-pay|521.37||||521.37|156.41|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|521.37||||521.37|109.49|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|TRUSTMARK [2030]|STARMARK [203000]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|521.37||||521.37|133|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|UMR [2035]|UMR OPTIONS [203501]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|521.37||||521.37|0|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|521.37||||521.37|469.23|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|521.37||||521.37|192.91|484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|521.37||||521.37||484.87|109.49
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|521.37||||521.37|260.68|484.87|109.49
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|100.62||||100.62|0|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100.62||||100.62|0|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100.62||||100.62|0|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|100.62||||100.62|0|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100.62||||100.62|0|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100.62||||100.62|43.27|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|100.62||||100.62|0|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|100.62||||100.62|50.31|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100.62||||100.62|65.4|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|100.62||||100.62|0|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|100.62||||100.62|37.23|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|GEHA [1415]|GEHA [141500]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100.62||||100.62|43.27|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|100.62||||100.62|93.58|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|100.62||||100.62|33.2|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100.62||||100.62|0|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100.62||||100.62|0|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|MULTIPLAN [1680]|HMA [168003]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|MULTIPLAN [1680]|IHC HS [168011]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|100.62||||100.62|0|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|Self-pay|Self-pay|100.62||||100.62|30.19|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100.62||||100.62|21.13|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|TRUSTMARK [2030]|STARMARK [203000]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100.62||||100.62|25.67|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|UMR [2035]|UMR OPTIONS [203501]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100.62||||100.62|0|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|100.62||||100.62|90.56|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|100.62||||100.62|37.23|93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|100.62||||100.62||93.58|21.13
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|100.62||||100.62|50.31|93.58|21.13
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|315.75||||315.75|0|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|315.75||||315.75|0|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|315.75||||315.75|0|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|315.75||||315.75|0|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|315.75||||315.75|0|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|315.75||||315.75|135.77|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|315.75||||315.75|0|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|315.75||||315.75|157.88|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|315.75||||315.75|205.24|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|315.75||||315.75|154.72|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|315.75||||315.75|201.77|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|GEHA [1415]|GEHA [141500]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|315.75||||315.75|135.77|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|315.75||||315.75|293.65|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|315.75||||315.75|104.2|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|315.75||||315.75|157.88|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|315.75||||315.75|0|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|MULTIPLAN [1680]|HMA [168003]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|MULTIPLAN [1680]|IHC HS [168011]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|315.75||||315.75|0|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|Self-pay|Self-pay|315.75||||315.75|94.72|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|315.75||||315.75|66.31|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|TRUSTMARK [2030]|STARMARK [203000]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|315.75||||315.75|80.55|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|UMR [2035]|UMR OPTIONS [203501]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|315.75||||315.75|0|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|315.75||||315.75|284.18|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|315.75||||315.75|201.77|293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|315.75||||315.75||293.65|66.31
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE LEAD BARB STERILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|315.75||||315.75|157.88|293.65|66.31
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|105.25||||105.25|0|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|105.25||||105.25|0|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|105.25||||105.25|0|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|105.25||||105.25|0|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|105.25||||105.25|0|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|105.25||||105.25|45.26|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|105.25||||105.25|0|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|105.25||||105.25|52.63|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|105.25||||105.25|68.41|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|CORESOURCE [1315]|CORESOURCE [131500]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|105.25||||105.25|0|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|105.25||||105.25|38.94|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|GEHA [1415]|GEHA [141500]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|HEALTHNET [1495]|HEALTHNET [149500]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|105.25||||105.25|45.26|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|105.25||||105.25|97.88|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|105.25||||105.25|34.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|105.25||||105.25|52.63|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|105.25||||105.25|0|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|MULTIPLAN [1680]|HMA [168003]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|MULTIPLAN [1680]|IHC HS [168011]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|105.25||||105.25|0|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|Self-pay|Self-pay|105.25||||105.25|31.57|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|105.25||||105.25|22.1|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|TRUSTMARK [2030]|STARMARK [203000]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|105.25||||105.25|26.85|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|UMR [2035]|UMR OPTIONS [203501]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|105.25||||105.25|0|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|105.25||||105.25|94.73|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|105.25||||105.25|38.94|97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|105.25||||105.25||97.88|22.1
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|105.25||||105.25|52.63|97.88|22.1
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|3666.92|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|27.18|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|3666.92|3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||3666.92|22.38
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|3666.92|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|27.18|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|3666.92|3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||3666.92|22.38
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|3666.92|22.38
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|5712.97||||5712.97|1999.54|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5712.97||||5712.97|0|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5712.97||||5712.97|0|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5712.97||||5712.97|0|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5712.97||||5712.97|0|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5712.97||||5712.97|2456.58|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5712.97||||5712.97|0|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5712.97||||5712.97|2856.49|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5712.97||||5712.97|3713.43|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|CORESOURCE [1315]|CORESOURCE [131500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5712.97||||5712.97|2799.36|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5712.97||||5712.97|1169.3|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|GEHA [1415]|GEHA [141500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5712.97||||5712.97|1999.54|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|HEALTHNET [1495]|HEALTHNET [149500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5712.97||||5712.97|2456.58|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5712.97||||5712.97|5313.06|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5712.97||||5712.97|1885.28|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5712.97||||5712.97|2856.49|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5712.97||||5712.97|0|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|MULTIPLAN [1680]|HMA [168003]|5712.97||||5712.97|1999.54|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|MULTIPLAN [1680]|IHC HS [168011]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5712.97||||5712.97|0|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|Self-pay|Self-pay|5712.97||||5712.97|1713.89|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5712.97||||5712.97|1199.72|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|TRUSTMARK [2030]|STARMARK [203000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5712.97||||5712.97|1457.38|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|UMR [2035]|UMR OPTIONS [203501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5712.97||||5712.97|0|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|5712.97||||5712.97|5141.67|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5712.97||||5712.97|1169.3|5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5712.97||||5712.97||5313.06|1169.3
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5712.97||||5712.97|2856.49|5313.06|1169.3
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|3666.92|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|Self-pay|Self-pay|106.56||||106.56|31.97|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|27.18|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|3666.92|3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||3666.92|22.38
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|3666.92|22.38
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|5712.97||||5712.97|1999.54|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5712.97||||5712.97|0|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5712.97||||5712.97|0|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5712.97||||5712.97|0|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5712.97||||5712.97|0|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5712.97||||5712.97|2456.58|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5712.97||||5712.97|0|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5712.97||||5712.97|2856.49|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5712.97||||5712.97|3713.43|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|CORESOURCE [1315]|CORESOURCE [131500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5712.97||||5712.97|2799.36|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5712.97||||5712.97|1169.3|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|GEHA [1415]|GEHA [141500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5712.97||||5712.97|1999.54|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|HEALTHNET [1495]|HEALTHNET [149500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5712.97||||5712.97|2456.58|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5712.97||||5712.97|5313.06|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5712.97||||5712.97|1885.28|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5712.97||||5712.97|2856.49|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5712.97||||5712.97|0|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|MULTIPLAN [1680]|HMA [168003]|5712.97||||5712.97|1999.54|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|MULTIPLAN [1680]|IHC HS [168011]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5712.97||||5712.97|0|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|Self-pay|Self-pay|5712.97||||5712.97|1713.89|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5712.97||||5712.97|1199.72|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|TRUSTMARK [2030]|STARMARK [203000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5712.97||||5712.97|1457.38|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|UMR [2035]|UMR OPTIONS [203501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5712.97||||5712.97|0|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|5712.97||||5712.97|5141.67|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5712.97||||5712.97|1169.3|5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5712.97||||5712.97||5313.06|1169.3
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5712.97||||5712.97|2856.49|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|5712.97||||5712.97|1999.54|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5712.97||||5712.97|0|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5712.97||||5712.97|0|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5712.97||||5712.97|0|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5712.97||||5712.97|0|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5712.97||||5712.97|2456.58|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5712.97||||5712.97|0|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5712.97||||5712.97|2856.49|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5712.97||||5712.97|3713.43|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|CORESOURCE [1315]|CORESOURCE [131500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5712.97||||5712.97|2799.36|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5712.97||||5712.97|1169.3|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|GEHA [1415]|GEHA [141500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5712.97||||5712.97|1999.54|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|HEALTHNET [1495]|HEALTHNET [149500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5712.97||||5712.97|2456.58|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5712.97||||5712.97|5313.06|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5712.97||||5712.97|1885.28|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5712.97||||5712.97|2856.49|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5712.97||||5712.97|0|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|MULTIPLAN [1680]|HMA [168003]|5712.97||||5712.97|1999.54|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|MULTIPLAN [1680]|IHC HS [168011]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|5712.97||||5712.97|0|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|Self-pay|Self-pay|5712.97||||5712.97|1713.89|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5712.97||||5712.97|1199.72|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|TRUSTMARK [2030]|STARMARK [203000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5712.97||||5712.97|1457.38|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|UMR [2035]|UMR OPTIONS [203501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5712.97||||5712.97|0|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|5712.97||||5712.97|5141.67|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|5712.97||||5712.97|1169.3|5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|5712.97||||5712.97||5313.06|1169.3
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|5712.97||||5712.97|2856.49|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5712.97||||5712.97||5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|AETNA [1015]|AETNA ACO WILCO [101532]|5712.97||||5712.97|1999.54|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5712.97||||5712.97||5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5712.97||||5712.97||5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5712.97||||5712.97|0|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5712.97||||5712.97|0|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5712.97||||5712.97||5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|5712.97||||5712.97|0|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5712.97||||5712.97|0|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5712.97||||5712.97|2456.58|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|5712.97||||5712.97|0|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|5712.97||||5712.97|2856.49|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5712.97||||5712.97|3713.43|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5712.97||||5712.97||5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5712.97||||5712.97||5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|CORESOURCE [1315]|CORESOURCE [131500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|CORVEL CORP [2235]|CORVEL CORP [223500]|5712.97||||5712.97|2799.36|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|5712.97||||5712.97|1169.3|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|GEHA [1415]|GEHA [141500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|5712.97||||5712.97|1999.54|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|HEALTHNET [1495]|HEALTHNET [149500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5712.97||||5712.97|2456.58|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|HEALTHSMART [1505]|HEALTHSMART [150501]|5712.97||||5712.97|5313.06|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5712.97||||5712.97|1885.28|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5712.97||||5712.97||5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|5712.97||||5712.97||5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5712.97||||5712.97|5141.67|5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5712.97||||5712.97||5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5712.97||||5712.97||5313.06|1169.3
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5712.97||||5712.97|2856.49|53