"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"
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|AETNA [1015]|AETNA ACO WILCO [101532]|11678.96||||11678.96|4087.64|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11678.96||||11678.96|0|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11678.96||||11678.96|0|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|11678.96||||11678.96|0|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11678.96||||11678.96|0|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11678.96||||11678.96|5021.95|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|11678.96||||11678.96|0|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|11678.96||||11678.96|5839.48|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11678.96||||11678.96|7591.32|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|CORESOURCE [1315]|CORESOURCE [131500]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|CORVEL CORP [2235]|CORVEL CORP [223500]|11678.96||||11678.96|5722.69|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|11678.96||||11678.96|1653.91|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|GEHA [1415]|GEHA [141500]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|11678.96||||11678.96|4087.64|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|HEALTHNET [1495]|HEALTHNET [149500]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11678.96||||11678.96|5021.95|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|HEALTHSMART [1505]|HEALTHSMART [150501]|11678.96||||11678.96|10861.43|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|11678.96||||11678.96|3854.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11678.96||||11678.96|5839.48|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11678.96||||11678.96|0|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|MULTIPLAN [1680]|HMA [168003]|11678.96||||11678.96|4087.64|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|MULTIPLAN [1680]|IHC HS [168011]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|11678.96||||11678.96|0|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|Self-pay|Self-pay|11678.96||||11678.96|3503.69|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11678.96||||11678.96|2452.58|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|TRUSTMARK [2030]|STARMARK [203000]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11678.96||||11678.96|2743.39|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|UMR [2035]|UMR OPTIONS [203501]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11678.96||||11678.96|0|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|11678.96||||11678.96|10511.06|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|11678.96||||11678.96|1653.91|10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|11678.96||||11678.96||10861.43|1653.91
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|11678.96||||11678.96|5839.48|10861.43|1653.91
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|3.66||||3.66|0|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3.66||||3.66|0|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3.66||||3.66|0|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3.66||||3.66|0|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3.66||||3.66|0|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3.66||||3.66|1.57|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3.66||||3.66|0|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3.66||||3.66|1.83|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3.66||||3.66|2.38|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3.66||||3.66|0|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3.66||||3.66|1.36|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|GEHA [1415]|GEHA [141500]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3.66||||3.66|1.57|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3.66||||3.66|3.41|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3.66||||3.66|1.21|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3.66||||3.66|0|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3.66||||3.66|0|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MULTIPLAN [1680]|HMA [168003]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MULTIPLAN [1680]|IHC HS [168011]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3.66||||3.66|0|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|Self-pay|Self-pay|3.66||||3.66|1.1|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3.66||||3.66|0.77|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|TRUSTMARK [2030]|STARMARK [203000]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3.66||||3.66|0.86|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UMR [2035]|UMR OPTIONS [203501]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3.66||||3.66|0|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|3.66||||3.66|3.3|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3.66||||3.66|1.36|3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3.66||||3.66||3.41|0.77
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3.66||||3.66|1.83|3.41|0.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AETNA [1015]|AETNA ACO WILCO [101532]|279.88||||279.88|0|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|279.88||||279.88|0|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|279.88||||279.88|0|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|279.88||||279.88|0|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|279.88||||279.88|0|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|279.88||||279.88|120.35|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|279.88||||279.88|0|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|279.88||||279.88|139.94|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|279.88||||279.88|181.92|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CORESOURCE [1315]|CORESOURCE [131500]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|CORVEL CORP [2235]|CORVEL CORP [223500]|279.88||||279.88|0|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|279.88||||279.88|103.56|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|GEHA [1415]|GEHA [141500]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HEALTHNET [1495]|HEALTHNET [149500]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|279.88||||279.88|120.35|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|279.88||||279.88|260.29|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|279.88||||279.88|92.36|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|279.88||||279.88|0|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|279.88||||279.88|0|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MULTIPLAN [1680]|HMA [168003]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MULTIPLAN [1680]|IHC HS [168011]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|279.88||||279.88|0|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|Self-pay|Self-pay|279.88||||279.88|83.96|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|279.88||||279.88|58.77|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|TRUSTMARK [2030]|STARMARK [203000]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|279.88||||279.88|65.74|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UMR [2035]|UMR OPTIONS [203501]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|279.88||||279.88|0|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|279.88||||279.88|251.89|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|279.88||||279.88|103.56|260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|279.88||||279.88||260.29|58.77
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|50 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|279.88||||279.88|139.94|260.29|58.77
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|2.35|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
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|120.49|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
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA ACO WILCO [101532]|191.01||||191.01|0|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|191.01||||191.01|0|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|191.01||||191.01|0|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|191.01||||191.01|0|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|191.01||||191.01|0|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|191.01||||191.01|82.13|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|191.01||||191.01|0|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|191.01||||191.01|95.5|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|191.01||||191.01|124.16|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CORESOURCE [1315]|CORESOURCE [131500]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|191.01||||191.01|93.59|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|191.01||||191.01|394.96|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GEHA [1415]|GEHA [141500]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHNET [1495]|HEALTHNET [149500]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|191.01||||191.01|82.13|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|191.01||||191.01|177.64|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|191.01||||191.01|63.03|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|191.01||||191.01|95.5|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|191.01||||191.01|0|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MULTIPLAN [1680]|HMA [168003]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MULTIPLAN [1680]|IHC HS [168011]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|191.01||||191.01|0|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|Self-pay|Self-pay|191.01||||191.01|57.3|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|191.01||||191.01|40.11|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|TRUSTMARK [2030]|STARMARK [203000]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|191.01||||191.01|44.87|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UMR [2035]|UMR OPTIONS [203501]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|191.01||||191.01|0|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|191.01||||191.01|171.91|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|191.01||||191.01|394.96|394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|191.01||||191.01||394.96|40.11
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|191.01||||191.01|95.5|394.96|40.11
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|192.61||||192.61|0|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.61||||192.61|0|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.61||||192.61|0|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|192.61||||192.61|0|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.61||||192.61|0|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.61||||192.61|82.82|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|192.61||||192.61|0|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|192.61||||192.61|96.3|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.61||||192.61|125.19|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|192.61||||192.61|94.38|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|192.61||||192.61|394.96|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.61||||192.61|82.82|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|192.61||||192.61|179.12|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|192.61||||192.61|63.56|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.61||||192.61|96.3|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.61||||192.61|0|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|192.61||||192.61|0|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|Self-pay|Self-pay|192.61||||192.61|57.78|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.61||||192.61|40.45|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.61||||192.61|45.24|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.61||||192.61|0|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|192.61||||192.61|173.35|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|192.61||||192.61|394.96|394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|192.61||||192.61||394.96|40.45
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|192.61||||192.61|96.3|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|AETNA [1015]|AETNA ACO WILCO [101532]|192.61||||192.61|0|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.61||||192.61|0|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.61||||192.61|0|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|192.61||||192.61|0|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.61||||192.61|0|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.61||||192.61|82.82|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|192.61||||192.61|0|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|192.61||||192.61|96.3|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.61||||192.61|125.19|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|CORESOURCE [1315]|CORESOURCE [131500]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|192.61||||192.61|94.38|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|192.61||||192.61|394.96|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|GEHA [1415]|GEHA [141500]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|HEALTHNET [1495]|HEALTHNET [149500]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.61||||192.61|82.82|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|192.61||||192.61|179.12|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|192.61||||192.61|63.56|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.61||||192.61|96.3|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.61||||192.61|0|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|MULTIPLAN [1680]|HMA [168003]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|MULTIPLAN [1680]|IHC HS [168011]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|192.61||||192.61|0|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|Self-pay|Self-pay|192.61||||192.61|57.78|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.61||||192.61|40.45|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|TRUSTMARK [2030]|STARMARK [203000]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.61||||192.61|45.24|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|UMR [2035]|UMR OPTIONS [203501]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.61||||192.61|0|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|192.61||||192.61|173.35|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|192.61||||192.61|394.96|394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|192.61||||192.61||394.96|40.45
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|192.61||||192.61|96.3|394.96|40.45
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|22.38
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|22.38
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|24.58|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|394.96|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||394.96|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|394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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||394.96|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|394.96|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||394.96|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||394.96|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|394.96|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|394.96|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||394.96|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||394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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||394.96|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||394.96|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|394.96|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|25.03|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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|394.96|394.96|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||394.96|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|394.96|22.38
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|4556.43|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||4556.43|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|4556.43|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||4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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||4556.43|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|4556.43|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|4556.43|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||4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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||4556.43|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||4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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|1653.91|4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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||4556.43|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||4556.43|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|4556.43|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||4556.43|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||4556.43|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|4556.43|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|4556.43|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||4556.43|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||4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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|4556.43|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||4556.43|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|4556.43|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|4556.43|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||4556.43|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|4556.43|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|4556.43|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||4556.43|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||4556.43|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||4556.43|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|4556.43|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|1150.87|4556.43|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|4556.43|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|4556.43|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||4556.43|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|4556.43|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|4556.43|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||4556.43|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|1653.91|4556.43|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||4556.43|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|4556.43|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|464.94|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||464.94|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|464.94|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||464.94|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|464.94|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|464.94|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|464.94|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|464.94|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||464.94|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|464.94|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|464.94|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||464.94|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|464.94|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|464.94|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|464.94|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|464.94|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|464.94|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|464.94|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|464.94|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||464.94|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||464.94|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|464.94|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|464.94|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|464.94|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|464.94|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|464.94|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|394.96|464.94|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|464.94|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|464.94|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|464.94|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||464.94|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|464.94|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|464.94|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|464.94|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|464.94|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|464.94|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|464.94|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||464.94|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||464.94|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|464.94|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||464.94|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||464.94|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|464.94|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|464.94|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||464.94|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||464.94|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||464.94|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|464.94|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|464.94|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|464.94|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|464.94|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|464.94|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||464.94|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|464.94|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|464.94|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||464.94|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|464.94|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|464.94|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||464.94|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||464.94|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||464.94|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|464.94|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|117.44|464.94|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|464.94|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|464.94|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||464.94|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|464.94|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|464.94|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||464.94|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|394.96|464.94|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||464.94|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|464.94|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|1653.91|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|1150.87|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|1653.91|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
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|394.96|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||394.96|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|394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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||394.96|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|394.96|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||394.96|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||394.96|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|394.96|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|394.96|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||394.96|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||394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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||394.96|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||394.96|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|394.96|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|25.03|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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|394.96|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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|394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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||394.96|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|394.96|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||394.96|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||394.96|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|394.96|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|394.96|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||394.96|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||394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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||394.96|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||394.96|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|394.96|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|25.03|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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|394.96|394.96|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||394.96|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|394.96|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|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|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||394.96|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|394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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||394.96|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|394.96|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||394.96|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||394.96|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|394.96|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|394.96|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||394.96|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||394.96|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||394.96|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|394.96|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|394.96|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|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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||394.96|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||394.96|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|394.96|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|25.03|394.96|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|394.96|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|394.96|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||394.96|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|394.96|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|394.96|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||394.96|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|394.96|394.96|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||394.96|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|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|22.38
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|22.38
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|22.38
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|22.38
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L28 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|22.38
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|22.38
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|22.38
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|0|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|0|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|0|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|10||||10|3.3|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|2.35|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|10||||10|9|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||394.96|2.1
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|2.1
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|2.1
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|22.38
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|22.38
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|22.38
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L40 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|22.38
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|0|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|0|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|0|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|10||||10|3.3|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|2.35|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|10||||10|9|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||394.96|2.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|2.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|2.1
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|22.38
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L50 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|22.38
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|22.38
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|0|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|0|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|0|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|10||||10|3.3|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|2.35|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|10||||10|9|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||394.96|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|2.1
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|2.1
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|107.36||||107.36|0|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107.36||||107.36|0|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107.36||||107.36|0|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107.36||||107.36|0|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107.36||||107.36|0|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107.36||||107.36|46.16|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107.36||||107.36|0|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107.36||||107.36|53.68|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107.36||||107.36|69.78|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107.36||||107.36|52.6|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107.36||||107.36|394.96|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107.36||||107.36|46.16|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107.36||||107.36|99.84|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|107.36||||107.36|35.43|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107.36||||107.36|53.68|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107.36||||107.36|0|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107.36||||107.36|0|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|107.36||||107.36|32.21|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107.36||||107.36|22.54|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107.36||||107.36|25.22|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107.36||||107.36|0|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|107.36||||107.36|96.62|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107.36||||107.36|394.96|394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107.36||||107.36||394.96|22.54
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107.36||||107.36|53.68|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|107.36||||107.36|0|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107.36||||107.36|0|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107.36||||107.36|0|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107.36||||107.36|0|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107.36||||107.36|0|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107.36||||107.36|46.16|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107.36||||107.36|0|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107.36||||107.36|53.68|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107.36||||107.36|69.78|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107.36||||107.36|52.6|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107.36||||107.36|394.96|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107.36||||107.36|46.16|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107.36||||107.36|99.84|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|107.36||||107.36|35.43|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107.36||||107.36|53.68|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107.36||||107.36|0|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107.36||||107.36|0|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|107.36||||107.36|32.21|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107.36||||107.36|22.54|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107.36||||107.36|25.22|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107.36||||107.36|0|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|107.36||||107.36|96.62|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107.36||||107.36|394.96|394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107.36||||107.36||394.96|22.54
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107.36||||107.36|53.68|394.96|22.54
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|522.04||||522.04|0|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|522.04||||522.04|0|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|522.04||||522.04|0|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|522.04||||522.04|0|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|522.04||||522.04|0|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|522.04||||522.04|224.48|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|522.04||||522.04|0|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|522.04||||522.04|261.02|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|522.04||||522.04|339.33|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|522.04||||522.04|255.8|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|522.04||||522.04|394.96|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|GEHA [1415]|GEHA [141500]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|522.04||||522.04|224.48|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|522.04||||522.04|485.5|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|522.04||||522.04|172.27|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|522.04||||522.04|261.02|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|522.04||||522.04|0|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|MULTIPLAN [1680]|HMA [168003]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|MULTIPLAN [1680]|IHC HS [168011]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|522.04||||522.04|0|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|Self-pay|Self-pay|522.04||||522.04|156.61|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|522.04||||522.04|109.63|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|TRUSTMARK [2030]|STARMARK [203000]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|522.04||||522.04|122.63|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|UMR [2035]|UMR OPTIONS [203501]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|522.04||||522.04|0|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|522.04||||522.04|469.84|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|522.04||||522.04|394.96|485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|522.04||||522.04||485.5|109.63
100464|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L20 MM OD4.3 MM HUMERUS HEXALOBE LOW PROFILE NONSTERILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|522.04||||522.04|261.02|485.5|109.63
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|3789||||3789|1326.15|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3789||||3789|0|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3789||||3789|0|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3789||||3789|0|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3789||||3789|0|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3789||||3789|1629.27|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3789||||3789|0|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3789||||3789|1894.5|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3789||||3789|2462.85|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|3789||||3789|1856.61|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3789||||3789|1653.91|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|GEHA [1415]|GEHA [141500]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3789||||3789|1326.15|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3789||||3789|1629.27|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3789||||3789|3523.77|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3789||||3789|1250.37|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3789||||3789|1894.5|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3789||||3789|0|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|MULTIPLAN [1680]|HMA [168003]|3789||||3789|1326.15|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|MULTIPLAN [1680]|IHC HS [168011]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3789||||3789|0|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|Self-pay|Self-pay|3789||||3789|1136.7|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3789||||3789|795.69|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|TRUSTMARK [2030]|STARMARK [203000]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3789||||3789|890.04|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|UMR [2035]|UMR OPTIONS [203501]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3789||||3789|0|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|3789||||3789|3410.1|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3789||||3789|1653.91|3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3789||||3789||3523.77|795.69
100479|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SURFACE ARTICULAR PERSONA VIVACIT-E 6-9 E-F H13 MM KNEE LEFT POSTERIOR STABILIZE STERILE LATEX FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3789||||3789|1894.5|3523.77|795.69
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|107.36||||107.36|0|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107.36||||107.36|0|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107.36||||107.36|0|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107.36||||107.36|0|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107.36||||107.36|0|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107.36||||107.36|46.16|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107.36||||107.36|0|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107.36||||107.36|53.68|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107.36||||107.36|69.78|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107.36||||107.36|52.6|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107.36||||107.36|394.96|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107.36||||107.36|46.16|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107.36||||107.36|99.84|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|107.36||||107.36|35.43|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107.36||||107.36|53.68|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107.36||||107.36|0|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107.36||||107.36|0|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|107.36||||107.36|32.21|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107.36||||107.36|22.54|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107.36||||107.36|25.22|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107.36||||107.36|0|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|107.36||||107.36|96.62|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107.36||||107.36|394.96|394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107.36||||107.36||394.96|22.54
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107.36||||107.36|53.68|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|107.36||||107.36|0|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107.36||||107.36|0|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107.36||||107.36|0|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107.36||||107.36|0|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107.36||||107.36|0|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107.36||||107.36|46.16|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107.36||||107.36|0|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107.36||||107.36|53.68|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107.36||||107.36|69.78|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107.36||||107.36|52.6|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107.36||||107.36|394.96|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107.36||||107.36|46.16|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107.36||||107.36|99.84|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|107.36||||107.36|35.43|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107.36||||107.36|53.68|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107.36||||107.36|0|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107.36||||107.36|0|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|107.36||||107.36|32.21|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107.36||||107.36|22.54|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107.36||||107.36|25.22|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107.36||||107.36|0|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|107.36||||107.36|96.62|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107.36||||107.36|394.96|394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107.36||||107.36||394.96|22.54
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107.36||||107.36|53.68|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|107.36||||107.36|0|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107.36||||107.36|0|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107.36||||107.36|0|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107.36||||107.36|0|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107.36||||107.36|0|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107.36||||107.36|46.16|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107.36||||107.36|0|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107.36||||107.36|53.68|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107.36||||107.36|69.78|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107.36||||107.36|52.6|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107.36||||107.36|394.96|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107.36||||107.36|46.16|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107.36||||107.36|99.84|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|107.36||||107.36|35.43|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107.36||||107.36|53.68|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107.36||||107.36|0|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107.36||||107.36|0|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|107.36||||107.36|32.21|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107.36||||107.36|22.54|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107.36||||107.36|25.22|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107.36||||107.36|0|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|107.36||||107.36|96.62|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107.36||||107.36|394.96|394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107.36||||107.36||394.96|22.54
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107.36||||107.36|53.68|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|107.36||||107.36|0|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107.36||||107.36|0|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107.36||||107.36|0|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107.36||||107.36|0|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107.36||||107.36|0|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107.36||||107.36|46.16|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107.36||||107.36|0|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107.36||||107.36|53.68|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107.36||||107.36|69.78|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107.36||||107.36|52.6|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107.36||||107.36|394.96|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107.36||||107.36|46.16|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107.36||||107.36|99.84|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|107.36||||107.36|35.43|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107.36||||107.36|53.68|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107.36||||107.36|0|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107.36||||107.36|0|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|107.36||||107.36|32.21|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107.36||||107.36|22.54|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107.36||||107.36|25.22|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107.36||||107.36|0|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|107.36||||107.36|96.62|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107.36||||107.36|394.96|394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107.36||||107.36||394.96|22.54
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107.36||||107.36|53.68|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|107.36||||107.36|0|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107.36||||107.36|0|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107.36||||107.36|0|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107.36||||107.36|0|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107.36||||107.36|0|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107.36||||107.36|46.16|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107.36||||107.36|0|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107.36||||107.36|53.68|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107.36||||107.36|69.78|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107.36||||107.36|52.6|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107.36||||107.36|394.96|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107.36||||107.36|46.16|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107.36||||107.36|99.84|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|107.36||||107.36|35.43|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107.36||||107.36|53.68|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107.36||||107.36|0|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107.36||||107.36|0|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|107.36||||107.36|32.21|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107.36||||107.36|22.54|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107.36||||107.36|25.22|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107.36||||107.36|0|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|107.36||||107.36|96.62|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107.36||||107.36|394.96|394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107.36||||107.36||394.96|22.54
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107.36||||107.36|53.68|394.96|22.54
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|0|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|0|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|0|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|GEHA [1415]|GEHA [141500]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|10||||10|3.3|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|2.35|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|10||||10|9|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||394.96|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|107.36||||107.36|0|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107.36||||107.36|0|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107.36||||107.36|0|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107.36||||107.36|0|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107.36||||107.36|0|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107.36||||107.36|46.16|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107.36||||107.36|0|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107.36||||107.36|53.68|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107.36||||107.36|69.78|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107.36||||107.36|52.6|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107.36||||107.36|394.96|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107.36||||107.36|46.16|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107.36||||107.36|99.84|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|107.36||||107.36|35.43|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107.36||||107.36|53.68|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107.36||||107.36|0|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107.36||||107.36|0|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|Self-pay|Self-pay|107.36||||107.36|32.21|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107.36||||107.36|22.54|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107.36||||107.36|25.22|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107.36||||107.36|0|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|107.36||||107.36|96.62|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107.36||||107.36|394.96|394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107.36||||107.36||394.96|2.1
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107.36||||107.36|53.68|394.96|2.1
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|107.36||||107.36|0|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107.36||||107.36|0|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107.36||||107.36|0|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107.36||||107.36|0|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107.36||||107.36|0|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107.36||||107.36|46.16|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107.36||||107.36|0|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107.36||||107.36|53.68|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107.36||||107.36|69.78|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107.36||||107.36|52.6|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107.36||||107.36|394.96|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107.36||||107.36|46.16|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107.36||||107.36|99.84|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|107.36||||107.36|35.43|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107.36||||107.36|53.68|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107.36||||107.36|0|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107.36||||107.36|0|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|107.36||||107.36|32.21|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107.36||||107.36|22.54|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107.36||||107.36|25.22|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107.36||||107.36|0|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|107.36||||107.36|96.62|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107.36||||107.36|394.96|394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107.36||||107.36||394.96|22.54
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107.36||||107.36|53.68|394.96|22.54
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|AETNA [1015]|AETNA ACO WILCO [101532]|774.35||||774.35|0|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|774.35||||774.35|0|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|774.35||||774.35|0|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|774.35||||774.35|0|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|774.35||||774.35|0|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|774.35||||774.35|332.97|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|774.35||||774.35|0|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|774.35||||774.35|387.17|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|774.35||||774.35|503.32|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|CORESOURCE [1315]|CORESOURCE [131500]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|CORVEL CORP [2235]|CORVEL CORP [223500]|774.35||||774.35|0|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|774.35||||774.35|286.51|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|GEHA [1415]|GEHA [141500]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|HEALTHNET [1495]|HEALTHNET [149500]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|774.35||||774.35|332.97|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|HEALTHSMART [1505]|HEALTHSMART [150501]|774.35||||774.35|720.14|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|774.35||||774.35|255.53|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|774.35||||774.35|0|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|774.35||||774.35|0|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|MULTIPLAN [1680]|HMA [168003]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|MULTIPLAN [1680]|IHC HS [168011]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|774.35||||774.35|0|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|Self-pay|Self-pay|774.35||||774.35|232.31|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|774.35||||774.35|162.61|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|TRUSTMARK [2030]|STARMARK [203000]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|774.35||||774.35|181.89|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|UMR [2035]|UMR OPTIONS [203501]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|774.35||||774.35|0|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|774.35||||774.35|696.91|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|774.35||||774.35|286.51|720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|774.35||||774.35||720.14|162.61
100552|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE STRATAFIX 3-0 FS-2 SPIRAL L14 CM KNOTLESS TISSUE CONTROL 2 ARM UNDYED|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|774.35||||774.35|387.17|720.14|162.61
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|107.36||||107.36|0|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107.36||||107.36|0|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107.36||||107.36|0|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107.36||||107.36|0|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107.36||||107.36|0|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107.36||||107.36|46.16|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107.36||||107.36|0|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107.36||||107.36|53.68|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107.36||||107.36|69.78|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107.36||||107.36|52.6|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107.36||||107.36|394.96|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107.36||||107.36|46.16|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107.36||||107.36|99.84|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|107.36||||107.36|35.43|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107.36||||107.36|53.68|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107.36||||107.36|0|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107.36||||107.36|0|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|107.36||||107.36|32.21|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107.36||||107.36|22.54|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107.36||||107.36|25.22|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107.36||||107.36|0|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|107.36||||107.36|96.62|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107.36||||107.36|394.96|394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107.36||||107.36||394.96|22.54
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107.36||||107.36|53.68|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|107.36||||107.36|0|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107.36||||107.36|0|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107.36||||107.36|0|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|107.36||||107.36|0|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107.36||||107.36|0|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107.36||||107.36|46.16|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|107.36||||107.36|0|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|107.36||||107.36|53.68|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107.36||||107.36|69.78|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|107.36||||107.36|52.6|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|107.36||||107.36|394.96|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107.36||||107.36|46.16|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|107.36||||107.36|99.84|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|107.36||||107.36|35.43|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107.36||||107.36|53.68|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107.36||||107.36|0|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|107.36||||107.36|0|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|Self-pay|Self-pay|107.36||||107.36|32.21|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107.36||||107.36|22.54|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107.36||||107.36|25.22|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107.36||||107.36|0|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|107.36||||107.36|96.62|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|107.36||||107.36|394.96|394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|107.36||||107.36||394.96|22.54
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|107.36||||107.36|53.68|394.96|22.54
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|850.42||||850.42|0|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|850.42||||850.42|0|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|850.42||||850.42|0|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|850.42||||850.42|0|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|850.42||||850.42|0|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|850.42||||850.42|365.68|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|850.42||||850.42|0|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|850.42||||850.42|425.21|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|850.42||||850.42|552.77|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|850.42||||850.42|416.71|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|850.42||||850.42|394.96|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|GEHA [1415]|GEHA [141500]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|850.42||||850.42|365.68|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|850.42||||850.42|790.89|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|850.42||||850.42|280.64|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|850.42||||850.42|425.21|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|850.42||||850.42|0|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|MULTIPLAN [1680]|HMA [168003]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|MULTIPLAN [1680]|IHC HS [168011]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|850.42||||850.42|0|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|Self-pay|Self-pay|850.42||||850.42|255.13|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|850.42||||850.42|178.59|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|TRUSTMARK [2030]|STARMARK [203000]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|850.42||||850.42|199.76|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|UMR [2035]|UMR OPTIONS [203501]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|850.42||||850.42|0|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|850.42||||850.42|765.38|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|850.42||||850.42|394.96|790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|850.42||||850.42||790.89|178.59
100586|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ZP SHORT THREAD L26 MM OD3.2 MM FOOT ANKLE COMPRESSION NONSTERILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|850.42||||850.42|425.21|790.89|178.59
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|AETNA [1015]|AETNA ACO WILCO [101532]|42.1||||42.1|0|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42.1||||42.1|0|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42.1||||42.1|0|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|42.1||||42.1|0|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42.1||||42.1|0|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42.1||||42.1|18.1|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|42.1||||42.1|0|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|42.1||||42.1|21.05|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42.1||||42.1|27.37|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|CORESOURCE [1315]|CORESOURCE [131500]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|42.1||||42.1|0|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|42.1||||42.1|15.58|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|GEHA [1415]|GEHA [141500]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|HEALTHNET [1495]|HEALTHNET [149500]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42.1||||42.1|18.1|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|42.1||||42.1|39.15|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|42.1||||42.1|13.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42.1||||42.1|21.05|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42.1||||42.1|0|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|MULTIPLAN [1680]|HMA [168003]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|MULTIPLAN [1680]|IHC HS [168011]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|42.1||||42.1|0|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|Self-pay|Self-pay|42.1||||42.1|12.63|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42.1||||42.1|8.84|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|TRUSTMARK [2030]|STARMARK [203000]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42.1||||42.1|9.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|UMR [2035]|UMR OPTIONS [203501]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42.1||||42.1|0|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|42.1||||42.1|37.89|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|42.1||||42.1|15.58|39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|42.1||||42.1||39.15|8.84
100649|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN SURGICAL L150 MM OD1.6 MM FOOTMOTION PLATE SYSTEM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|42.1||||42.1|21.05|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|AETNA [1015]|AETNA ACO WILCO [101532]|42.1||||42.1|0|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42.1||||42.1|0|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42.1||||42.1|0|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|42.1||||42.1|0|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42.1||||42.1|0|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42.1||||42.1|18.1|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|42.1||||42.1|0|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|42.1||||42.1|21.05|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42.1||||42.1|27.37|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|CORESOURCE [1315]|CORESOURCE [131500]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|42.1||||42.1|0|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|42.1||||42.1|15.58|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|GEHA [1415]|GEHA [141500]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|HEALTHNET [1495]|HEALTHNET [149500]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42.1||||42.1|18.1|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|42.1||||42.1|39.15|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|42.1||||42.1|13.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42.1||||42.1|21.05|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42.1||||42.1|0|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|MULTIPLAN [1680]|HMA [168003]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|MULTIPLAN [1680]|IHC HS [168011]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|42.1||||42.1|0|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|Self-pay|Self-pay|42.1||||42.1|12.63|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42.1||||42.1|8.84|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|TRUSTMARK [2030]|STARMARK [203000]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42.1||||42.1|9.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|UMR [2035]|UMR OPTIONS [203501]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42.1||||42.1|0|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|42.1||||42.1|37.89|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|42.1||||42.1|15.58|39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|42.1||||42.1||39.15|8.84
100650|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PIN FIXATION L70 MM OD1.2 MM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|42.1||||42.1|21.05|39.15|8.84
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|AETNA [1015]|AETNA ACO WILCO [101532]|875.68||||875.68|0|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|875.68||||875.68|0|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|875.68||||875.68|0|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|875.68||||875.68|0|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|875.68||||875.68|0|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|875.68||||875.68|376.54|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|875.68||||875.68|0|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|875.68||||875.68|437.84|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|875.68||||875.68|569.19|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|CORESOURCE [1315]|CORESOURCE [131500]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|875.68||||875.68|0|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|875.68||||875.68|324|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|GEHA [1415]|GEHA [141500]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|HEALTHNET [1495]|HEALTHNET [149500]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|875.68||||875.68|376.54|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|875.68||||875.68|814.38|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|875.68||||875.68|288.97|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|875.68||||875.68|0|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|875.68||||875.68|0|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|MULTIPLAN [1680]|HMA [168003]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|MULTIPLAN [1680]|IHC HS [168011]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|875.68||||875.68|0|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|Self-pay|Self-pay|875.68||||875.68|262.7|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|875.68||||875.68|183.89|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|TRUSTMARK [2030]|STARMARK [203000]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|875.68||||875.68|205.7|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|UMR [2035]|UMR OPTIONS [203501]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|875.68||||875.68|0|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|875.68||||875.68|788.11|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|875.68||||875.68|324|814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|875.68||||875.68||814.38|183.89
100651|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD2 MM QUICK COUPLING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|875.68||||875.68|437.84|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|AETNA [1015]|AETNA ACO WILCO [101532]|875.68||||875.68|0|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|875.68||||875.68|0|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|875.68||||875.68|0|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|875.68||||875.68|0|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|875.68||||875.68|0|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|875.68||||875.68|376.54|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|875.68||||875.68|0|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|875.68||||875.68|437.84|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|875.68||||875.68|569.19|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|CORESOURCE [1315]|CORESOURCE [131500]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|CORVEL CORP [2235]|CORVEL CORP [223500]|875.68||||875.68|0|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|875.68||||875.68|324|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|GEHA [1415]|GEHA [141500]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|HEALTHNET [1495]|HEALTHNET [149500]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|875.68||||875.68|376.54|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|HEALTHSMART [1505]|HEALTHSMART [150501]|875.68||||875.68|814.38|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|875.68||||875.68|288.97|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|875.68||||875.68|0|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|875.68||||875.68|0|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|MULTIPLAN [1680]|HMA [168003]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|MULTIPLAN [1680]|IHC HS [168011]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|875.68||||875.68|0|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|Self-pay|Self-pay|875.68||||875.68|262.7|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|875.68||||875.68|183.89|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|TRUSTMARK [2030]|STARMARK [203000]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|875.68||||875.68|205.7|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|UMR [2035]|UMR OPTIONS [203501]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|875.68||||875.68|0|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|875.68||||875.68|788.11|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|875.68||||875.68|324|814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|875.68||||875.68||814.38|183.89
100652|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM OD3 MM QUICK COUPLING|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|875.68||||875.68|437.84|814.38|183.89
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|AETNA [1015]|AETNA ACO WILCO [101532]|700.54||||700.54|0|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|700.54||||700.54|0|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|700.54||||700.54|0|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|700.54||||700.54|0|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|700.54||||700.54|0|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|700.54||||700.54|301.23|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|700.54||||700.54|0|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|700.54||||700.54|350.27|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|700.54||||700.54|455.35|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|CORESOURCE [1315]|CORESOURCE [131500]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|CORVEL CORP [2235]|CORVEL CORP [223500]|700.54||||700.54|343.27|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|700.54||||700.54|394.96|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|GEHA [1415]|GEHA [141500]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|HEALTHNET [1495]|HEALTHNET [149500]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|700.54||||700.54|301.23|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|700.54||||700.54|651.51|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|700.54||||700.54|231.18|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|700.54||||700.54|350.27|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|700.54||||700.54|0|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|MULTIPLAN [1680]|HMA [168003]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|MULTIPLAN [1680]|IHC HS [168011]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|700.54||||700.54|0|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|Self-pay|Self-pay|700.54||||700.54|210.16|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|700.54||||700.54|147.11|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|TRUSTMARK [2030]|STARMARK [203000]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|700.54||||700.54|164.56|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|UMR [2035]|UMR OPTIONS [203501]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|700.54||||700.54|0|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|700.54||||700.54|630.49|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|700.54||||700.54|394.96|651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|700.54||||700.54||651.51|147.11
100654|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L16 MM OD2.8 MM LOCK GREEN ANODIZE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|700.54||||700.54|350.27|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|AETNA [1015]|AETNA ACO WILCO [101532]|700.54||||700.54|0|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|700.54||||700.54|0|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|700.54||||700.54|0|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|700.54||||700.54|0|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|700.54||||700.54|0|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|700.54||||700.54|301.23|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|700.54||||700.54|0|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|700.54||||700.54|350.27|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|700.54||||700.54|455.35|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|CORESOURCE [1315]|CORESOURCE [131500]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|CORVEL CORP [2235]|CORVEL CORP [223500]|700.54||||700.54|343.27|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|700.54||||700.54|394.96|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|GEHA [1415]|GEHA [141500]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|HEALTHNET [1495]|HEALTHNET [149500]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|700.54||||700.54|301.23|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|HEALTHSMART [1505]|HEALTHSMART [150501]|700.54||||700.54|651.51|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|700.54||||700.54|231.18|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|700.54||||700.54|350.27|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|700.54||||700.54|0|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|MULTIPLAN [1680]|HMA [168003]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|MULTIPLAN [1680]|IHC HS [168011]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|700.54||||700.54|0|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|Self-pay|Self-pay|700.54||||700.54|210.16|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|700.54||||700.54|147.11|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|TRUSTMARK [2030]|STARMARK [203000]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|700.54||||700.54|164.56|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|UMR [2035]|UMR OPTIONS [203501]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|700.54||||700.54|0|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|700.54||||700.54|630.49|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|700.54||||700.54|394.96|651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|700.54||||700.54||651.51|147.11
100658|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW LOCKING 2.8X14MM|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|700.54||||700.54|350.27|651.51|147.11
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|106.56||||106.56|0|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.56||||106.56|0|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.56||||106.56|0|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|106.56||||106.56|0|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.56||||106.56|0|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.56||||106.56|45.82|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|106.56||||106.56|0|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|106.56||||106.56|53.28|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.56||||106.56|69.26|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CORVEL CORP [2235]|CORVEL CORP [223500]|106.56||||106.56|52.21|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|106.56||||106.56|394.96|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GEHA [1415]|GEHA [141500]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.56||||106.56|45.82|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|106.56||||106.56|99.1|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.56||||106.56|35.16|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.56||||106.56|53.28|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.56||||106.56|0|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|106.56||||106.56|0|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|Self-pay|Self-pay|106.56||||106.56|31.97|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.56||||106.56|22.38|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.56||||106.56|25.03|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.56||||106.56|0|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|106.56||||106.56|95.9|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|106.56||||106.56|394.96|394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|106.56||||106.56||394.96|22.38
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|106.56||||106.56|53.28|394.96|22.38
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|CORVEL CORP [2235]|CORVEL CORP [223500]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|GEHA [1415]|GEHA [141500]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|10||||10|3.3|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10069|ERX