"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"
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|AETNA [1015]|AETNA ACO WILCO [101532]|6531.18||||6531.18|2285.91|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|6531.18||||6531.18|4571.83|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6531.18||||6531.18|3265.59|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6531.18||||6531.18|0|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6531.18||||6531.18|0|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|6531.18||||6531.18|3781.56|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6531.18||||6531.18|2645.13|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6531.18||||6531.18|2808.41|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|6531.18||||6531.18|3213.34|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|6531.18||||6531.18|3265.59|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6531.18||||6531.18|4245.27|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|6531.18||||6531.18|4571.83|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|CORESOURCE [1315]|CORESOURCE [131500]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|6531.18||||6531.18|10.8|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|6531.18||||6531.18|5551.51|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|GEHA [1415]|GEHA - ASA [141503]|6531.18||||6531.18|0|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|GROUP PENSION ADMIN [1450]|GPA [145000]|6531.18||||6531.18|4571.83|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|6531.18||||6531.18|2285.91|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|HEALTHNET [1495]|HEALTHNET [149500]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6531.18||||6531.18|2808.41|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6531.18||||6531.18|5029.01|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|HEALTHSMART [1505]|HEALTHSMART [150501]|6531.18||||6531.18|6074|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6531.18||||6531.18|2155.29|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6531.18||||6531.18|4245.27|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6531.18||||6531.18|3265.59|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6531.18||||6531.18|0|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|MULTIPLAN [1680]|HMA [168003]|6531.18||||6531.18|2285.91|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|MULTIPLAN [1680]|IHC HS [168011]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|6531.18||||6531.18|0|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6531.18||||6531.18|4245.27|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|6531.18||||6531.18|4571.83|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|Self-pay|Self-pay|6531.18||||6531.18|1959.35|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6531.18||||6531.18|1371.55|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|TRUSTMARK [2030]|STARMARK [203000]|6531.18||||6531.18|5878.07|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6531.18||||6531.18|2083.45|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|UMR [2035]|UMR OPTIONS [203501]|6531.18||||6531.18|0|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6531.18||||6531.18|0|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|6531.18||||6531.18|0|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|6531.18||||6531.18|10.8|6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|6531.18||||6531.18||6074|10.8
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|6531.18||||6531.18|3265.59|6074|10.8
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|29||||29|20.3|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29|14.5|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|16.79|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|11.75|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|14.27|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|29||||29|20.3|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|29||||29|24.65|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|GEHA [1415]|GEHA - ASA [141503]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA [145000]|29||||29|20.3|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|22.33|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|29||||29|9.57|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29|18.85|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MULTIPLAN [1680]|HMA [168003]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29|18.85|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|29||||29|20.3|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|Self-pay|Self-pay|29||||29|8.7|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|9.25|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|AETNA [1015]|AETNA ACO WILCO [101532]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|29||||29|20.3|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29||||29|14.5|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|29||||29|16.79|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29||||29|11.75|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29||||29|12.47|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|29||||29|14.27|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|29||||29|14.5|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29||||29|18.85|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|29||||29|20.3|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|CORESOURCE [1315]|CORESOURCE [131500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|29||||29|10.73|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|29||||29|24.65|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|GEHA [1415]|GEHA - ASA [141503]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|GROUP PENSION ADMIN [1450]|GPA [145000]|29||||29|20.3|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|HEALTHNET [1495]|HEALTHNET [149500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29||||29|12.47|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29||||29|22.33|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|29||||29|26.97|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|29||||29|9.57|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29||||29|18.85|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|MULTIPLAN [1680]|HMA [168003]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|MULTIPLAN [1680]|IHC HS [168011]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29||||29|18.85|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|29||||29|20.3|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|Self-pay|Self-pay|29||||29|8.7|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29||||29|6.09|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|TRUSTMARK [2030]|STARMARK [203000]|29||||29|26.1|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29||||29|9.25|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|UMR [2035]|UMR OPTIONS [203501]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|29||||29|0|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|29||||29|10.73|26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|29||||29||26.97|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|4 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|29||||29|14.5|26.97|6.09
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]|AMERICAN CONTINENTAL [101507]|10||||10|7|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|5|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|5.79|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|4.05|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|4.92|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|CIGNA [1260]|CIGNA - GREAT WEST [126009]|10||||10|7|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|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]|BENVEO/UCS [137512]|10||||10|8.5|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 - ASA [141503]|10||||10|0|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA [145000]|10||||10|7|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|7.7|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|6.5|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|6.5|9.3|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1 tablet|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|10||||10|7|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|3.19|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|0|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]|UHC - BIND [206032]|10||||10|0|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|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AETNA [1015]|AETNA ACO WILCO [101532]|512.93||||512.93|0|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|512.93||||512.93||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|512.93||||512.93|359.05|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|512.93||||512.93|461.64|477.02|95.48
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|95.48
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|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|512.93||||512.93|256.47|477.02|95.48
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|95.48
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|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|512.93||||512.93|296.99|477.02|95.48
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|207.74|477.02|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|512.93||||512.93|252.36|477.02|95.48
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|95.48
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|95.48
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|95.48
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|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|512.93||||512.93|359.05|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|CORESOURCE [1315]|CORESOURCE [131500]|512.93||||512.93|461.64|477.02|95.48
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|95.48
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|95.48
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|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|512.93||||512.93|435.99|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|512.93||||512.93|461.64|477.02|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|GEHA [1415]|GEHA - ASA [141503]|512.93||||512.93|0|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|GROUP PENSION ADMIN [1450]|GPA [145000]|512.93||||512.93|359.05|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|512.93||||512.93||477.02|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HEALTHNET [1495]|HEALTHNET [149500]|512.93||||512.93|461.64|477.02|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|512.93||||512.93|394.96|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|512.93||||512.93|477.02|477.02|95.48
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|95.48
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|95.48
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|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|512.93||||512.93|333.4|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|512.93||||512.93||477.02|95.48
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|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|512.93||||512.93||477.02|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MULTIPLAN [1680]|HMA [168003]|512.93||||512.93||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|MULTIPLAN [1680]|IHC HS [168011]|512.93||||512.93|461.64|477.02|95.48
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|95.48
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|95.48
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|95.48
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|95.48
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|95.48
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|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|512.93||||512.93|333.4|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|512.93||||512.93|359.05|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|Self-pay|Self-pay|512.93||||512.93|153.88|477.02|95.48
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|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|512.93||||512.93||477.02|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|TRUSTMARK [2030]|STARMARK [203000]|512.93||||512.93|461.64|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|512.93||||512.93|163.62|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UMR [2035]|UMR OPTIONS [203501]|512.93||||512.93|0|477.02|95.48
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|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|250 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|512.93||||512.93|0|477.02|95.48
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|95.48
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|95.48
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|95.48
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|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|AETNA [1015]|AETNA ACO WILCO [101532]|454.65||||454.65|0|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|454.65||||454.65|318.26|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|454.65||||454.65|227.33|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|454.65||||454.65|0|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|454.65||||454.65|0|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|454.65||||454.65|263.24|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|454.65||||454.65|184.13|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|454.65||||454.65|195.5|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|454.65||||454.65|223.69|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|454.65||||454.65|227.33|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|454.65||||454.65|295.52|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|454.65||||454.65|318.26|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|CORESOURCE [1315]|CORESOURCE [131500]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|454.65||||454.65|168.22|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|454.65||||454.65|386.45|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|GEHA [1415]|GEHA - ASA [141503]|454.65||||454.65|0|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|GROUP PENSION ADMIN [1450]|GPA [145000]|454.65||||454.65|318.26|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|HEALTHNET [1495]|HEALTHNET [149500]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|454.65||||454.65|195.5|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|454.65||||454.65|350.08|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|454.65||||454.65|422.82|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|454.65||||454.65|150.03|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|454.65||||454.65|295.52|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|454.65||||454.65|0|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|454.65||||454.65|0|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|MULTIPLAN [1680]|HMA [168003]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|MULTIPLAN [1680]|IHC HS [168011]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|454.65||||454.65|0|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|454.65||||454.65|295.52|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|454.65||||454.65|318.26|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|Self-pay|Self-pay|454.65||||454.65|136.39|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|454.65||||454.65|95.48|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|TRUSTMARK [2030]|STARMARK [203000]|454.65||||454.65|409.19|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|454.65||||454.65|145.03|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|UMR [2035]|UMR OPTIONS [203501]|454.65||||454.65|0|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|454.65||||454.65|0|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|454.65||||454.65|0|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|454.65||||454.65|168.22|477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|454.65||||454.65||477.02|95.48
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|500 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|454.65||||454.65|227.33|477.02|95.48
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|192.61||||192.61|0|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|192.61||||192.61|134.83|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.61||||192.61|96.3|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.61||||192.61|0|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.61||||192.61|0|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|192.61||||192.61|111.52|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.61||||192.61|78.01|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.61||||192.61|82.82|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|192.61||||192.61|94.76|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|192.61||||192.61|96.3|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.61||||192.61|125.19|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|192.61||||192.61|134.83|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|192.61||||192.61|10.8|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|192.61||||192.61|163.72|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GEHA [1415]|GEHA - ASA [141503]|192.61||||192.61|0|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|192.61||||192.61|134.83|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.61||||192.61|82.82|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.61||||192.61|148.31|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|192.61||||192.61|179.12|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|192.61||||192.61|63.56|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.61||||192.61|125.19|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.61||||192.61|96.3|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.61||||192.61|0|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|192.61||||192.61|0|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.61||||192.61|125.19|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|192.61||||192.61|134.83|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|Self-pay|Self-pay|192.61||||192.61|57.78|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.61||||192.61|40.45|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|192.61||||192.61|173.35|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.61||||192.61|61.44|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|192.61||||192.61|0|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.61||||192.61|0|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|192.61||||192.61|0|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|192.61||||192.61|10.8|179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|192.61||||192.61||179.12|10.8
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|192.61||||192.61|96.3|179.12|10.8
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1305.1||||1305.1|913.57|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1305.1||||1305.1|652.55|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|755.65|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|528.57|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|642.11|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1305.1||||1305.1|913.57|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|974.41|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1305.1||||1305.1|1109.34|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|1305.1||||1305.1|913.57|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1305.1||||1305.1|561.19|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1004.93|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1|848.32|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1305.1||||1305.1|652.55|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1|848.32|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1305.1||||1305.1|913.57|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1305.1||||1305.1|416.33|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1305.1||||1305.1|0|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1305.1||||1305.1|974.41|1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1305.1||||1305.1|913.57|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1305.1||||1305.1|652.55|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|755.65|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|528.57|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|642.11|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1305.1||||1305.1|913.57|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|974.41|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1305.1||||1305.1|1109.34|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|1305.1||||1305.1|913.57|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1305.1||||1305.1|561.19|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1004.93|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1|848.32|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1305.1||||1305.1|652.55|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1|848.32|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1305.1||||1305.1|913.57|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1305.1||||1305.1|416.33|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1305.1||||1305.1|0|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1305.1||||1305.1|974.41|1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1305.1||||1305.1|913.57|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1305.1||||1305.1|652.55|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|755.65|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|528.57|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|642.11|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1305.1||||1305.1|913.57|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|974.41|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1305.1||||1305.1|1109.34|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|1305.1||||1305.1|913.57|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1305.1||||1305.1|561.19|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1004.93|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1|848.32|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1305.1||||1305.1|652.55|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1|848.32|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1305.1||||1305.1|913.57|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1305.1||||1305.1|416.33|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1305.1||||1305.1|0|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1305.1||||1305.1|974.41|1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1305.1||||1305.1|913.57|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1305.1||||1305.1|652.55|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|755.65|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|528.57|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|642.11|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1305.1||||1305.1|913.57|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|974.41|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1305.1||||1305.1|1109.34|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|1305.1||||1305.1|913.57|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1305.1||||1305.1|561.19|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1004.93|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1|848.32|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1305.1||||1305.1|652.55|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1|848.32|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1305.1||||1305.1|913.57|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1305.1||||1305.1|416.33|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1305.1||||1305.1|0|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1305.1||||1305.1|974.41|1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1305.1||||1305.1|913.57|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1305.1||||1305.1|652.55|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|755.65|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|528.57|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|642.11|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1305.1||||1305.1|913.57|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|974.41|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1305.1||||1305.1|1109.34|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|1305.1||||1305.1|913.57|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1305.1||||1305.1|561.19|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1004.93|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1|848.32|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1305.1||||1305.1|652.55|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1|848.32|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1305.1||||1305.1|913.57|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1305.1||||1305.1|416.33|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1305.1||||1305.1|0|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1305.1||||1305.1|974.41|1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|192.61||||192.61|0|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|192.61||||192.61|134.83|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.61||||192.61|96.3|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.61||||192.61|0|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.61||||192.61|0|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|192.61||||192.61|111.52|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.61||||192.61|78.01|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.61||||192.61|82.82|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|192.61||||192.61|94.76|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|192.61||||192.61|96.3|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.61||||192.61|125.19|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|192.61||||192.61|134.83|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|192.61||||192.61|10.8|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|192.61||||192.61|163.72|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GEHA [1415]|GEHA - ASA [141503]|192.61||||192.61|0|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|192.61||||192.61|134.83|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.61||||192.61|82.82|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.61||||192.61|148.31|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|192.61||||192.61|179.12|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|192.61||||192.61|63.56|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.61||||192.61|125.19|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.61||||192.61|96.3|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.61||||192.61|0|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|192.61||||192.61|0|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.61||||192.61|125.19|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|192.61||||192.61|134.83|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|Self-pay|Self-pay|192.61||||192.61|57.78|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.61||||192.61|40.45|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|192.61||||192.61|173.35|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.61||||192.61|61.44|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|192.61||||192.61|0|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.61||||192.61|0|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|192.61||||192.61|0|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|192.61||||192.61|10.8|179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|192.61||||192.61||179.12|10.8
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|192.61||||192.61|96.3|179.12|10.8
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1305.1||||1305.1|913.57|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1305.1||||1305.1|652.55|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|755.65|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|528.57|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|642.11|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1305.1||||1305.1|913.57|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|974.41|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1305.1||||1305.1|1109.34|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|1305.1||||1305.1|913.57|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1305.1||||1305.1|561.19|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1004.93|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1|848.32|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1305.1||||1305.1|652.55|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1|848.32|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1305.1||||1305.1|913.57|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1305.1||||1305.1|416.33|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1305.1||||1305.1|0|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1305.1||||1305.1|974.41|1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|192.61||||192.61|0|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|192.61||||192.61|134.83|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.61||||192.61|96.3|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.61||||192.61|0|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.61||||192.61|0|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|192.61||||192.61|111.52|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.61||||192.61|78.01|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.61||||192.61|82.82|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|192.61||||192.61|94.76|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|192.61||||192.61|96.3|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.61||||192.61|125.19|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|192.61||||192.61|134.83|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|192.61||||192.61|10.8|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|192.61||||192.61|163.72|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GEHA [1415]|GEHA - ASA [141503]|192.61||||192.61|0|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|192.61||||192.61|134.83|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.61||||192.61|82.82|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.61||||192.61|148.31|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|192.61||||192.61|179.12|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|192.61||||192.61|63.56|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.61||||192.61|125.19|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.61||||192.61|96.3|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.61||||192.61|0|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|192.61||||192.61|0|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.61||||192.61|125.19|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|192.61||||192.61|134.83|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|Self-pay|Self-pay|192.61||||192.61|57.78|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.61||||192.61|40.45|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|192.61||||192.61|173.35|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.61||||192.61|61.44|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|192.61||||192.61|0|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.61||||192.61|0|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|192.61||||192.61|0|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|192.61||||192.61|10.8|179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|192.61||||192.61||179.12|10.8
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|192.61||||192.61|96.3|179.12|10.8
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1305.1||||1305.1|913.57|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1305.1||||1305.1|652.55|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|755.65|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|528.57|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|642.11|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1305.1||||1305.1|913.57|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|974.41|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1305.1||||1305.1|1109.34|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|1305.1||||1305.1|913.57|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1305.1||||1305.1|561.19|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1004.93|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1|848.32|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1305.1||||1305.1|652.55|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1|848.32|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1305.1||||1305.1|913.57|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1305.1||||1305.1|416.33|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1305.1||||1305.1|0|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1305.1||||1305.1|974.41|1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1305.1||||1305.1|913.57|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1305.1||||1305.1|652.55|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1305.1||||1305.1|755.65|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.1||||1305.1|528.57|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.1||||1305.1|561.19|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1305.1||||1305.1|642.11|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1305.1||||1305.1|652.55|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.1||||1305.1|848.32|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1305.1||||1305.1|913.57|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|CORESOURCE [1315]|CORESOURCE [131500]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1305.1||||1305.1|974.41|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1305.1||||1305.1|1109.34|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GEHA [1415]|GEHA - ASA [141503]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|1305.1||||1305.1|913.57|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHNET [1495]|HEALTHNET [149500]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1305.1||||1305.1|561.19|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.1||||1305.1|1004.93|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1305.1||||1305.1|1213.74|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1305.1||||1305.1|430.68|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.1||||1305.1|848.32|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1305.1||||1305.1|652.55|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|HMA [168003]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MULTIPLAN [1680]|IHC HS [168011]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.1||||1305.1|848.32|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1305.1||||1305.1|913.57|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|Self-pay|Self-pay|1305.1||||1305.1|391.53|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.1||||1305.1|274.07|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|TRUSTMARK [2030]|STARMARK [203000]|1305.1||||1305.1|1174.59|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1305.1||||1305.1|416.33|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UMR [2035]|UMR OPTIONS [203501]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1305.1||||1305.1|0|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1305.1||||1305.1|974.41|1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1305.1||||1305.1||1213.74|274.07
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1305.1||||1305.1|652.55|1213.74|274.07
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|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA ACO WILCO [101532]|192.61||||192.61|0|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|192.61||||192.61|134.83|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.61||||192.61|96.3|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.61||||192.61|0|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.61||||192.61|0|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|192.61||||192.61|111.52|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.61||||192.61|78.01|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.61||||192.61|82.82|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|192.61||||192.61|94.76|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|192.61||||192.61|96.3|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.61||||192.61|125.19|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|192.61||||192.61|134.83|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|CORESOURCE [1315]|CORESOURCE [131500]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|192.61||||192.61|10.8|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|192.61||||192.61|163.72|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|GEHA [1415]|GEHA - ASA [141503]|192.61||||192.61|0|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|192.61||||192.61|134.83|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHNET [1495]|HEALTHNET [149500]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.61||||192.61|82.82|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.61||||192.61|148.31|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HEALTHSMART [1505]|HEALTHSMART [150501]|192.61||||192.61|179.12|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|192.61||||192.61|63.56|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.61||||192.61|125.19|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.61||||192.61|96.3|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.61||||192.61|0|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MULTIPLAN [1680]|HMA [168003]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MULTIPLAN [1680]|IHC HS [168011]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|192.61||||192.61|0|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.61||||192.61|125.19|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|192.61||||192.61|134.83|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|Self-pay|Self-pay|192.61||||192.61|57.78|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.61||||192.61|40.45|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|TRUSTMARK [2030]|STARMARK [203000]|192.61||||192.61|173.35|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.61||||192.61|61.44|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UMR [2035]|UMR OPTIONS [203501]|192.61||||192.61|0|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.61||||192.61|0|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|192.61||||192.61|0|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|192.61||||192.61|10.8|179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|192.61||||192.61||179.12|10.8
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM CORTEX SELF TAP SMALL HEXAGONAL SOCKET SPHERICAL HEAD NONSTERILE MODULAR MINI FRAGMENT SET|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|192.61||||192.61|96.3|179.12|10.8
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|AETNA [1015]|AETNA ACO WILCO [101532]|631.5||||631.5|0|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|631.5||||631.5|442.05|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|631.5||||631.5|315.75|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|631.5||||631.5|0|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|631.5||||631.5|0|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|631.5||||631.5|365.64|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|631.5||||631.5|255.76|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|631.5||||631.5|271.55|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|631.5||||631.5|310.7|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|631.5||||631.5|315.75|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|631.5||||631.5|410.48|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|631.5||||631.5|442.05|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|CORESOURCE [1315]|CORESOURCE [131500]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|631.5||||631.5|974.41|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|631.5||||631.5|536.78|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|GEHA [1415]|GEHA - ASA [141503]|631.5||||631.5|0|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|GROUP PENSION ADMIN [1450]|GPA [145000]|631.5||||631.5|442.05|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|HEALTHNET [1495]|HEALTHNET [149500]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|631.5||||631.5|271.55|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|631.5||||631.5|486.26|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|631.5||||631.5|587.3|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|631.5||||631.5|208.4|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|631.5||||631.5|410.48|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|631.5||||631.5|315.75|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|631.5||||631.5|0|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|MULTIPLAN [1680]|HMA [168003]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|MULTIPLAN [1680]|IHC HS [168011]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|631.5||||631.5|0|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|631.5||||631.5|410.48|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|631.5||||631.5|442.05|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|Self-pay|Self-pay|631.5||||631.5|189.45|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|631.5||||631.5|132.62|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|TRUSTMARK [2030]|STARMARK [203000]|631.5||||631.5|568.35|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|631.5||||631.5|201.45|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|UMR [2035]|UMR OPTIONS [203501]|631.5||||631.5|0|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|631.5||||631.5|0|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|631.5||||631.5|0|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|631.5||||631.5|974.41|974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|631.5||||631.5||974.41|132.62
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II +3 MM TAPER HIP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|631.5||||631.5|315.75|974.41|132.62
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|315.75||||315.75|0|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|315.75||||315.75|221.03|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|315.75||||315.75|157.88|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|315.75||||315.75|0|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|315.75||||315.75|0|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|315.75||||315.75|182.82|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|315.75||||315.75|127.88|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|315.75||||315.75|135.77|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|315.75||||315.75|155.35|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|315.75||||315.75|157.88|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|315.75||||315.75|205.24|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|315.75||||315.75|221.03|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|315.75||||315.75|974.41|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|315.75||||315.75|268.39|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|GEHA [1415]|GEHA - ASA [141503]|315.75||||315.75|0|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|315.75||||315.75|221.03|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|315.75||||315.75|135.77|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|315.75||||315.75|243.13|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|315.75||||315.75|293.65|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|315.75||||315.75|104.2|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|315.75||||315.75|205.24|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|315.75||||315.75|157.88|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|315.75||||315.75|0|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|MULTIPLAN [1680]|HMA [168003]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|MULTIPLAN [1680]|IHC HS [168011]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|315.75||||315.75|0|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|315.75||||315.75|205.24|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|315.75||||315.75|221.03|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|Self-pay|Self-pay|315.75||||315.75|94.72|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|315.75||||315.75|66.31|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|TRUSTMARK [2030]|STARMARK [203000]|315.75||||315.75|284.18|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|315.75||||315.75|100.72|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|UMR [2035]|UMR OPTIONS [203501]|315.75||||315.75|0|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|315.75||||315.75|0|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|315.75||||315.75|0|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|315.75||||315.75|974.41|974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|315.75||||315.75||974.41|66.31
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|315.75||||315.75|157.88|974.41|66.31
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1263||||1263|0|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1263||||1263|884.1|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1263||||1263|631.5|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1263||||1263|0|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1263||||1263|0|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1263||||1263|731.28|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1263||||1263|511.52|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1263||||1263|543.09|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1263||||1263|621.4|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1263||||1263|631.5|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1263||||1263|820.95|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1263||||1263|884.1|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1263||||1263|974.41|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1263||||1263|1073.55|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|GEHA [1415]|GEHA - ASA [141503]|1263||||1263|0|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|1263||||1263|884.1|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1263||||1263|543.09|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1263||||1263|972.51|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1263||||1263|1174.59|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1263||||1263|416.79|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1263||||1263|820.95|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1263||||1263|631.5|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1263||||1263|0|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|MULTIPLAN [1680]|HMA [168003]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|MULTIPLAN [1680]|IHC HS [168011]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1263||||1263|0|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1263||||1263|820.95|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1263||||1263|884.1|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|Self-pay|Self-pay|1263||||1263|378.9|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1263||||1263|265.23|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|TRUSTMARK [2030]|STARMARK [203000]|1263||||1263|1136.7|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1263||||1263|402.9|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|UMR [2035]|UMR OPTIONS [203501]|1263||||1263|0|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1263||||1263|0|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1263||||1263|0|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1263||||1263|974.41|1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1263||||1263||1174.59|265.23
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL BIO-MOORE ENDO II OD57 MM HIP STERILE LATEX FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1263||||1263|631.5|1174.59|265.23
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|3789||||3789|1326.15|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|3789||||3789|2652.3|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3789||||3789|1894.5|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3789||||3789|0|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3789||||3789|0|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3789||||3789|2193.83|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3789||||3789|1534.55|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3789||||3789|1629.27|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3789||||3789|1864.19|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3789||||3789|1894.5|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3789||||3789|2462.85|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|3789||||3789|2652.3|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|CORESOURCE [1315]|CORESOURCE [131500]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3789||||3789|974.41|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|3789||||3789|3220.65|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|GEHA [1415]|GEHA - ASA [141503]|3789||||3789|0|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|GROUP PENSION ADMIN [1450]|GPA [145000]|3789||||3789|2652.3|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3789||||3789|1326.15|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HEALTHNET [1495]|HEALTHNET [149500]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3789||||3789|1629.27|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3789||||3789|2917.53|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3789||||3789|3523.77|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3789||||3789|1250.37|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3789||||3789|2462.85|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3789||||3789|1894.5|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3789||||3789|0|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MULTIPLAN [1680]|HMA [168003]|3789||||3789|1326.15|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MULTIPLAN [1680]|IHC HS [168011]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3789||||3789|0|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3789||||3789|2462.85|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|3789||||3789|2652.3|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|Self-pay|Self-pay|3789||||3789|1136.7|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3789||||3789|795.69|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|TRUSTMARK [2030]|STARMARK [203000]|3789||||3789|3410.1|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3789||||3789|1208.69|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|UMR [2035]|UMR OPTIONS [203501]|3789||||3789|0|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3789||||3789|0|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3789||||3789|0|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3789||||3789|974.41|3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3789||||3789||3523.77|795.69
100270|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 71MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3789||||3789|1894.5|3523.77|795.69
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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||99.1|10.8
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]|AMERICAN CONTINENTAL [101507]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|53.28|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|61.7|99.1|10.8
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|43.15|99.1|10.8
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|99.1|10.8
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|52.43|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|10.8|99.1|10.8
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]|BENVEO/UCS [137512]|106.56||||106.56|90.57|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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 - ASA [141503]|106.56||||106.56|0|99.1|10.8
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|106.56||||106.56|74.59|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|82.05|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|33.99|99.1|10.8
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|0|99.1|10.8
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|99.1|10.8
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||99.1|10.8
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106.56||||106.56|0|99.1|10.8
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||99.1|10.8
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|10.8|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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||99.1|10.8
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]|AMERICAN CONTINENTAL [101507]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|53.28|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|61.7|99.1|10.8
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|43.15|99.1|10.8
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|99.1|10.8
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|52.43|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|10.8|99.1|10.8
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]|BENVEO/UCS [137512]|106.56||||106.56|90.57|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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 - ASA [141503]|106.56||||106.56|0|99.1|10.8
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|106.56||||106.56|74.59|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|82.05|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|33.99|99.1|10.8
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|0|99.1|10.8
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|99.1|10.8
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||99.1|10.8
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106.56||||106.56|0|99.1|10.8
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||99.1|10.8
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|10.8|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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||99.1|10.8
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]|AMERICAN CONTINENTAL [101507]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|53.28|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|61.7|99.1|10.8
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|43.15|99.1|10.8
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|99.1|10.8
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|52.43|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|10.8|99.1|10.8
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]|BENVEO/UCS [137512]|106.56||||106.56|90.57|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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 - ASA [141503]|106.56||||106.56|0|99.1|10.8
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|106.56||||106.56|74.59|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|82.05|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|33.99|99.1|10.8
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|0|99.1|10.8
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|99.1|10.8
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||99.1|10.8
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106.56||||106.56|0|99.1|10.8
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||99.1|10.8
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|10.8|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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||99.1|10.8
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]|AMERICAN CONTINENTAL [101507]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|53.28|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|61.7|99.1|10.8
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|43.15|99.1|10.8
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|99.1|10.8
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|52.43|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|10.8|99.1|10.8
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]|BENVEO/UCS [137512]|106.56||||106.56|90.57|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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 - ASA [141503]|106.56||||106.56|0|99.1|10.8
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|106.56||||106.56|74.59|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|82.05|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|33.99|99.1|10.8
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|0|99.1|10.8
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|99.1|10.8
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||99.1|10.8
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106.56||||106.56|0|99.1|10.8
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||99.1|10.8
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|10.8|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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||99.1|10.8
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]|AMERICAN CONTINENTAL [101507]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|53.28|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|61.7|99.1|10.8
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|43.15|99.1|10.8
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|99.1|10.8
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|52.43|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|10.8|99.1|10.8
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]|BENVEO/UCS [137512]|106.56||||106.56|90.57|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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 - ASA [141503]|106.56||||106.56|0|99.1|10.8
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|106.56||||106.56|74.59|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|82.05|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|33.99|99.1|10.8
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|0|99.1|10.8
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|99.1|10.8
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||99.1|10.8
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L26 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106.56||||106.56|0|99.1|10.8
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||99.1|10.8
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|10.8|99.1|10.8
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||99.1|10.8
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|99.1|10.8
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|AETNA [1015]|AETNA ACO WILCO [101532]|544.61||||544.61|0|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|544.61||||544.61|381.22|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|544.61||||544.61|272.3|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|544.61||||544.61|0|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|544.61||||544.61|0|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|544.61||||544.61|315.33|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|544.61||||544.61|220.57|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|544.61||||544.61|234.18|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|544.61||||544.61|267.95|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|544.61||||544.61|272.3|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|544.61||||544.61|353.99|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|544.61||||544.61|381.22|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|CORESOURCE [1315]|CORESOURCE [131500]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|544.61||||544.61|201.5|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|544.61||||544.61|462.91|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|GEHA [1415]|GEHA - ASA [141503]|544.61||||544.61|0|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|GROUP PENSION ADMIN [1450]|GPA [145000]|544.61||||544.61|381.22|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|HEALTHNET [1495]|HEALTHNET [149500]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|544.61||||544.61|234.18|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|544.61||||544.61|419.35|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|HEALTHSMART [1505]|HEALTHSMART [150501]|544.61||||544.61|506.48|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|544.61||||544.61|179.72|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|544.61||||544.61|353.99|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|544.61||||544.61|272.3|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|544.61||||544.61|0|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|MULTIPLAN [1680]|HMA [168003]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|MULTIPLAN [1680]|IHC HS [168011]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|544.61||||544.61|0|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|544.61||||544.61|353.99|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|544.61||||544.61|381.22|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|Self-pay|Self-pay|544.61||||544.61|163.39|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|544.61||||544.61|114.37|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|TRUSTMARK [2030]|STARMARK [203000]|544.61||||544.61|490.15|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|544.61||||544.61|173.73|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|UMR [2035]|UMR OPTIONS [203501]|544.61||||544.61|0|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|544.61||||544.61|0|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|544.61||||544.61|0|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|544.61||||544.61|201.5|506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|544.61||||544.61||506.48|114.37
100338|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER POWERGLIDE PRO L10 CM OD18 GA MAXIMAL BARRIER|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|544.61||||544.61|272.3|506.48|114.37
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|AETNA [1015]|AETNA ACO WILCO [101532]|4188.95||||4188.95|0|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|4188.95||||4188.95|2932.27|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4188.95||||4188.95|2094.48|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4188.95||||4188.95|0|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4188.95||||4188.95|0|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|4188.95||||4188.95|2425.4|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4188.95||||4188.95|1696.52|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4188.95||||4188.95|1801.25|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|4188.95||||4188.95|2060.96|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|4188.95||||4188.95|2094.48|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4188.95||||4188.95|2722.82|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|4188.95||||4188.95|2932.27|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|CORESOURCE [1315]|CORESOURCE [131500]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|4188.95||||4188.95|1549.91|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|4188.95||||4188.95|3560.61|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|GEHA [1415]|GEHA - ASA [141503]|4188.95||||4188.95|0|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|GROUP PENSION ADMIN [1450]|GPA [145000]|4188.95||||4188.95|2932.27|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|HEALTHNET [1495]|HEALTHNET [149500]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4188.95||||4188.95|1801.25|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4188.95||||4188.95|3225.49|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|HEALTHSMART [1505]|HEALTHSMART [150501]|4188.95||||4188.95|3895.72|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4188.95||||4188.95|1382.35|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4188.95||||4188.95|2722.82|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4188.95||||4188.95|2094.48|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4188.95||||4188.95|0|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|MULTIPLAN [1680]|HMA [168003]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|MULTIPLAN [1680]|IHC HS [168011]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|4188.95||||4188.95|0|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4188.95||||4188.95|2722.82|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|4188.95||||4188.95|2932.27|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|Self-pay|Self-pay|4188.95||||4188.95|1256.68|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4188.95||||4188.95|879.68|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|TRUSTMARK [2030]|STARMARK [203000]|4188.95||||4188.95|3770.06|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4188.95||||4188.95|1336.28|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|UMR [2035]|UMR OPTIONS [203501]|4188.95||||4188.95|0|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4188.95||||4188.95|0|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|4188.95||||4188.95|0|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|4188.95||||4188.95|1549.91|3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|4188.95||||4188.95||3895.72|879.68
100342|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT MICROCATHETER ITRACK MICRO CANALOPLASTY|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|4188.95||||4188.95|2094.48|3895.72|879.68
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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||99.1|10.8
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]|AMERICAN CONTINENTAL [101507]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|53.28|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|61.7|99.1|10.8
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|43.15|99.1|10.8
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|99.1|10.8
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|52.43|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|10.8|99.1|10.8
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]|BENVEO/UCS [137512]|106.56||||106.56|90.57|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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 - ASA [141503]|106.56||||106.56|0|99.1|10.8
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|106.56||||106.56|74.59|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|82.05|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|33.99|99.1|10.8
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|0|99.1|10.8
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|99.1|10.8
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||99.1|10.8
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L30 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106.56||||106.56|0|99.1|10.8
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||99.1|10.8
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|10.8|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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||99.1|10.8
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]|AMERICAN CONTINENTAL [101507]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|53.28|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|61.7|99.1|10.8
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|43.15|99.1|10.8
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|99.1|10.8
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|52.43|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|10.8|99.1|10.8
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]|BENVEO/UCS [137512]|106.56||||106.56|90.57|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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 - ASA [141503]|106.56||||106.56|0|99.1|10.8
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|106.56||||106.56|74.59|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|82.05|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|33.99|99.1|10.8
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|0|99.1|10.8
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|99.1|10.8
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||99.1|10.8
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L32 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106.56||||106.56|0|99.1|10.8
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||99.1|10.8
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|10.8|99.1|10.8
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||99.1|10.8
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|99.1|10.8
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|373.47||||373.47|0|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|373.47||||373.47|261.43|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|373.47||||373.47|186.73|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|373.47||||373.47|0|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|373.47||||373.47|0|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|373.47||||373.47|216.24|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|373.47||||373.47|151.25|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|373.47||||373.47|160.59|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|373.47||||373.47|183.75|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|373.47||||373.47|186.73|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|373.47||||373.47|242.75|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|373.47||||373.47|261.43|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|CORESOURCE [1315]|CORESOURCE [131500]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|373.47||||373.47|138.18|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|373.47||||373.47|317.45|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|GEHA [1415]|GEHA - ASA [141503]|373.47||||373.47|0|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|373.47||||373.47|261.43|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|HEALTHNET [1495]|HEALTHNET [149500]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|373.47||||373.47|160.59|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|373.47||||373.47|287.57|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|373.47||||373.47|347.33|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|373.47||||373.47|123.24|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|373.47||||373.47|242.75|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|373.47||||373.47|0|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|373.47||||373.47|0|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|MULTIPLAN [1680]|HMA [168003]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|MULTIPLAN [1680]|IHC HS [168011]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|373.47||||373.47|0|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|373.47||||373.47|242.75|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|373.47||||373.47|261.43|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|Self-pay|Self-pay|373.47||||373.47|112.04|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|373.47||||373.47|78.43|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|TRUSTMARK [2030]|STARMARK [203000]|373.47||||373.47|336.12|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|373.47||||373.47|119.14|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|UMR [2035]|UMR OPTIONS [203501]|373.47||||373.47|0|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|373.47||||373.47|0|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|373.47||||373.47|0|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|373.47||||373.47|138.18|347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|373.47||||373.47||347.33|78.43
100363|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INTREPID ABS 30 D OD.9 MM INFUSION SLEEVE BALANCE TIP STERILE LATEX FREE DISPOSABLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|373.47||||373.47|186.73|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|373.47||||373.47|0|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|373.47||||373.47|261.43|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|373.47||||373.47|186.73|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|373.47||||373.47|0|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|373.47||||373.47|0|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|373.47||||373.47|216.24|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|373.47||||373.47|151.25|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|373.47||||373.47|160.59|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|373.47||||373.47|183.75|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|373.47||||373.47|186.73|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|373.47||||373.47|242.75|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|373.47||||373.47|261.43|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|CORESOURCE [1315]|CORESOURCE [131500]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|373.47||||373.47|138.18|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|373.47||||373.47|317.45|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|GEHA [1415]|GEHA - ASA [141503]|373.47||||373.47|0|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|373.47||||373.47|261.43|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|HEALTHNET [1495]|HEALTHNET [149500]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|373.47||||373.47|160.59|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|373.47||||373.47|287.57|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|373.47||||373.47|347.33|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|373.47||||373.47|123.24|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|373.47||||373.47|242.75|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|373.47||||373.47|0|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|373.47||||373.47|0|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|MULTIPLAN [1680]|HMA [168003]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|MULTIPLAN [1680]|IHC HS [168011]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|373.47||||373.47|0|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|373.47||||373.47|242.75|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|373.47||||373.47|261.43|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|Self-pay|Self-pay|373.47||||373.47|112.04|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|373.47||||373.47|78.43|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|TRUSTMARK [2030]|STARMARK [203000]|373.47||||373.47|336.12|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|373.47||||373.47|119.14|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|UMR [2035]|UMR OPTIONS [203501]|373.47||||373.47|0|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|373.47||||373.47|0|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|373.47||||373.47|0|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|373.47||||373.47|138.18|347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|373.47||||373.47||347.33|78.43
100364|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION 45 D OD.9 MM ABS TIP FLUID MANAGEMENT SYSTEM ULTRA SLEEVE STERILE DISPOSABLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|373.47||||373.47|186.73|347.33|78.43
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|394.9||||394.9|0|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|394.9||||394.9|276.43|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|394.9||||394.9|197.45|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|394.9||||394.9|0|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|394.9||||394.9|0|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|394.9||||394.9|228.65|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|394.9||||394.9|159.93|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|394.9||||394.9|169.81|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|394.9||||394.9|194.29|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|394.9||||394.9|197.45|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|394.9||||394.9|256.68|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|394.9||||394.9|276.43|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|CORESOURCE [1315]|CORESOURCE [131500]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|394.9||||394.9|146.11|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|394.9||||394.9|335.66|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|GEHA [1415]|GEHA - ASA [141503]|394.9||||394.9|0|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|394.9||||394.9|276.43|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|HEALTHNET [1495]|HEALTHNET [149500]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|394.9||||394.9|169.81|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|394.9||||394.9|304.07|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|394.9||||394.9|367.26|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|394.9||||394.9|130.32|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|394.9||||394.9|256.68|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|394.9||||394.9|0|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|394.9||||394.9|0|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|MULTIPLAN [1680]|HMA [168003]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|MULTIPLAN [1680]|IHC HS [168011]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|394.9||||394.9|0|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|394.9||||394.9|256.68|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|394.9||||394.9|276.43|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|Self-pay|Self-pay|394.9||||394.9|118.47|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|394.9||||394.9|82.93|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|TRUSTMARK [2030]|STARMARK [203000]|394.9||||394.9|355.41|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|394.9||||394.9|125.97|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|UMR [2035]|UMR OPTIONS [203501]|394.9||||394.9|0|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|394.9||||394.9|0|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|394.9||||394.9|0|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|394.9||||394.9|146.11|367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|394.9||||394.9||367.26|82.93
100365|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK PHACOEMULSIFICATION INFINITI KELMAN 45 D OD.9 MM ULTRA MINI FLARED TIP FLUID MANAGEMENT SYSTEM STERILE DISPOSABLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|394.9||||394.9|197.45|367.26|82.93
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|AETNA [1015]|AETNA ACO WILCO [101532]|23.16||||23.16|0|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|23.16||||23.16|16.21|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23.16||||23.16|11.58|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23.16||||23.16|0|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23.16||||23.16|0|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|23.16||||23.16|13.41|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23.16||||23.16|9.38|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23.16||||23.16|9.96|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|23.16||||23.16|11.39|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|23.16||||23.16|11.58|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23.16||||23.16|15.05|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|23.16||||23.16|16.21|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|CORESOURCE [1315]|CORESOURCE [131500]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|23.16||||23.16|8.57|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|23.16||||23.16|19.68|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|GEHA [1415]|GEHA - ASA [141503]|23.16||||23.16|0|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|GROUP PENSION ADMIN [1450]|GPA [145000]|23.16||||23.16|16.21|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|HEALTHNET [1495]|HEALTHNET [149500]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23.16||||23.16|9.96|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23.16||||23.16|17.83|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|23.16||||23.16|21.53|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|23.16||||23.16|7.64|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23.16||||23.16|15.05|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23.16||||23.16|0|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23.16||||23.16|0|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|MULTIPLAN [1680]|HMA [168003]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|MULTIPLAN [1680]|IHC HS [168011]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|23.16||||23.16|0|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23.16||||23.16|15.05|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|23.16||||23.16|16.21|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|Self-pay|Self-pay|23.16||||23.16|6.95|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23.16||||23.16|4.86|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|TRUSTMARK [2030]|STARMARK [203000]|23.16||||23.16|20.84|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23.16||||23.16|7.39|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|UMR [2035]|UMR OPTIONS [203501]|23.16||||23.16|0|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23.16||||23.16|0|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|23.16||||23.16|0|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|23.16||||23.16|8.57|21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|23.16||||23.16||21.53|4.86
100366|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS 500 ML INTRAOCULAR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|23.16||||23.16|11.58|21.53|4.86
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|228.48||||228.48|0|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|228.48||||228.48|159.93|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|228.48||||228.48|114.24|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|228.48||||228.48|0|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|228.48||||228.48|0|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|228.48||||228.48|132.29|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|228.48||||228.48|92.53|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|228.48||||228.48|98.24|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|228.48||||228.48|112.41|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|228.48||||228.48|114.24|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|228.48||||228.48|148.51|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|228.48||||228.48|159.93|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|CORESOURCE [1315]|CORESOURCE [131500]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|228.48||||228.48|84.54|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|228.48||||228.48|194.21|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|GEHA [1415]|GEHA - ASA [141503]|228.48||||228.48|0|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|228.48||||228.48|159.93|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|HEALTHNET [1495]|HEALTHNET [149500]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|228.48||||228.48|98.24|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|228.48||||228.48|175.93|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|228.48||||228.48|212.48|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|228.48||||228.48|75.4|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|228.48||||228.48|148.51|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|228.48||||228.48|0|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|228.48||||228.48|0|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|MULTIPLAN [1680]|HMA [168003]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|MULTIPLAN [1680]|IHC HS [168011]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|228.48||||228.48|0|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|228.48||||228.48|148.51|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|228.48||||228.48|159.93|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|Self-pay|Self-pay|228.48||||228.48|68.55|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|228.48||||228.48|47.98|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|TRUSTMARK [2030]|STARMARK [203000]|228.48||||228.48|205.63|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|228.48||||228.48|72.88|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|UMR [2035]|UMR OPTIONS [203501]|228.48||||228.48|0|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|228.48||||228.48|0|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|228.48||||228.48|0|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|228.48||||228.48|84.54|212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|228.48||||228.48||212.48|47.98
100367|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION IRRIGATION BSS PLUS 500 ML DISPOSABLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|228.48||||228.48|114.24|212.48|47.98
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|772.66||||772.66|0|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|772.66||||772.66|540.86|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|772.66||||772.66|386.33|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|772.66||||772.66|0|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|772.66||||772.66|0|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|772.66||||772.66|447.37|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|772.66||||772.66|312.93|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|772.66||||772.66|332.24|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|772.66||||772.66|380.15|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|772.66||||772.66|386.33|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|772.66||||772.66|502.23|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|772.66||||772.66|540.86|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|772.66||||772.66|285.88|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|772.66||||772.66|656.76|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|GEHA [1415]|GEHA - ASA [141503]|772.66||||772.66|0|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|772.66||||772.66|540.86|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|772.66||||772.66|332.24|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|772.66||||772.66|594.95|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|772.66||||772.66|718.58|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|772.66||||772.66|254.98|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|772.66||||772.66|502.23|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|772.66||||772.66|0|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|772.66||||772.66|0|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|MULTIPLAN [1680]|HMA [168003]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|MULTIPLAN [1680]|IHC HS [168011]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|772.66||||772.66|0|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|772.66||||772.66|502.23|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|772.66||||772.66|540.86|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|Self-pay|Self-pay|772.66||||772.66|231.8|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|772.66||||772.66|162.26|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|TRUSTMARK [2030]|STARMARK [203000]|772.66||||772.66|695.4|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|772.66||||772.66|246.48|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|UMR [2035]|UMR OPTIONS [203501]|772.66||||772.66|0|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|772.66||||772.66|0|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|772.66||||772.66|0|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|772.66||||772.66|285.88|718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|772.66||||772.66||718.58|162.26
100368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PROBE VITRECTOMY ALCON CENTURION ULTRAVIT OD23 GA ANTERIOR STERILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|772.66||||772.66|386.33|718.58|162.26
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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||99.1|10.8
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]|AMERICAN CONTINENTAL [101507]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|53.28|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|61.7|99.1|10.8
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|43.15|99.1|10.8
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|99.1|10.8
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|52.43|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|10.8|99.1|10.8
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]|BENVEO/UCS [137512]|106.56||||106.56|90.57|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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 - ASA [141503]|106.56||||106.56|0|99.1|10.8
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|106.56||||106.56|74.59|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|82.05|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|33.99|99.1|10.8
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|0|99.1|10.8
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|99.1|10.8
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||99.1|10.8
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106.56||||106.56|0|99.1|10.8
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||99.1|10.8
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|10.8|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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||99.1|10.8
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]|AMERICAN CONTINENTAL [101507]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|53.28|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|61.7|99.1|10.8
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|43.15|99.1|10.8
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|99.1|10.8
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|52.43|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|10.8|99.1|10.8
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]|BENVEO/UCS [137512]|106.56||||106.56|90.57|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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 - ASA [141503]|106.56||||106.56|0|99.1|10.8
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|106.56||||106.56|74.59|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|82.05|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|33.99|99.1|10.8
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|0|99.1|10.8
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|99.1|10.8
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||99.1|10.8
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106.56||||106.56|0|99.1|10.8
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||99.1|10.8
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|10.8|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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||99.1|10.8
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]|AMERICAN CONTINENTAL [101507]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|53.28|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|61.7|99.1|10.8
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|43.15|99.1|10.8
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|99.1|10.8
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|52.43|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|10.8|99.1|10.8
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]|BENVEO/UCS [137512]|106.56||||106.56|90.57|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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 - ASA [141503]|106.56||||106.56|0|99.1|10.8
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|GROUP PENSION ADMIN [1450]|GPA [145000]|106.56||||106.56|74.59|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|82.05|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|99.1|10.8
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|69.26|99.1|10.8
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|106.56||||106.56|74.59|99.1|10.8
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|99.1|10.8
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|99.1|10.8
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||99.1|10.8
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||99.1|10.8
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||99.1|10.8
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|99.1|10.8
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|33.99|99.1|10.8
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|0|99.1|10.8
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|99.1|10.8
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||99.1|10.8
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|106.56||||106.56|0|99.1|10.8
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||99.1|10.8
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|10.8|99.1|10.8
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||99.1|10.8
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|99.1|10.8
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA ACO WILCO [101532]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|AETNA [1015]|AMERICAN CONTINENTAL [101507]|10||||10|7|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10||||10|5|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|10||||10|5.79|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10||||10|4.05|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10||||10|4.3|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|10||||10|4.92|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|10||||10|5|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10||||10|6.5|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|CIGNA [1260]|CIGNA - GREAT WEST [126009]|10||||10|7|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|10||||10|3.7|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|BENVEO/UCS [137512]|10||||10|8.5|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|FIRST HEALTH [1375]|QUALCHOICE [137513]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|FMH BENEFIT SERVICES [1390]|FMH [139000]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|GEHA [1415]|GEHA - ASA [141503]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA [145000]|10||||10|7|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10||||10|4.3|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10||||10|7.7|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|HEALTHSMART [1505]|HEALTHSMART [150501]|10||||10|9.3|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|10||||10|3.3|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10||||10|6.5|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MULTIPLAN [1680]|IHC HS [168011]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10|6.5|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|10||||10|7|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|3.19|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|1 tablet|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10||||10|9|99.1|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||99.1|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|99.1|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||99.1|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|AETNA [1015]|AMERICAN CONTINENTAL [101507]|10||||10|7|99.1|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|99.1|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|99.1|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|99.1|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|99.1|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|5|99.1|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|99.1|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|99.1|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||99.1|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|5.79|99.1|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|4.05|99.1|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|99.1|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|4.92|99.1|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|99.1|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|99.1|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|99.1|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||99.1|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||99.1|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CIGNA [1260]|CIGNA - GREAT WEST [126009]|10||||10|7|99.1|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|CORESOURCE [1315]|CORESOURCE [131500]|10||||10|9|99.1|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|99.1|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|99.1|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|99.1|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|99.1|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|FIRST HEALTH [1375]|BENVEO/UCS [137512]|10||||10|8.5|99.1|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|99.1|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|99.1|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|GEHA [1415]|GEHA - ASA [141503]|10||||10|0|99.1|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA [145000]|10||||10|7|99.1|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||99.1|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|99.1|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|HEALTHNET [1495]|HEALTHNET [149500]|10||||10|9|99.1|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|99.1|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|7.7|99.1|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|99.1|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|99.1|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||99.1|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||99.1|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|99.1|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|6.5|99.1|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||99.1|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|99.1|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|99.1|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||99.1|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||99.1|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||99.1|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|99.1|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|99.1|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|99.1|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|99.1|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|99.1|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||99.1|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|99.1|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|99.1|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|6.5|99.1|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|10||||10|7|99.1|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|Self-pay|Self-pay|10||||10|3|99.1|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|99.1|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||99.1|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||99.1|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||99.1|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|99.1|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|3.19|99.1|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UMR [2035]|UMR OPTIONS [203501]|10||||10|0|99.1|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|99.1|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||99.1|2.1
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|99.1|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||99.1|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|99.1|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||99.1|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|99.1|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|99.1|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||99.1|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|99.1|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||99.1|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]|AMERICAN CONTINENTAL [101507]|106.56||||106.56|74.59|99.1|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|99.1|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|99.1|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|99.1|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|99.1|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|53.28|99.1|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|99.1|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|99.1|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||99.1|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|61.7|99.1|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|43.15|99.1|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|99.1|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|52.43|99.1|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|99.1|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|99.1|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|99.1|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||99.1|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||99.1|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 [1260]|CIGNA - GREAT WEST [126009]|106.56||||106.56|74.59|99.1|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|99.1|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|99.1|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|99.1|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|99.1|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|10.8|99.1|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]|BENVEO/UCS [137512]|106.56||||106.56|90.57|99.1|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|99.1|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|99.1|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 - ASA [141503]|106.56||||106.56|0|99.1|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 [145000]|106.56||||106.56|74.59|99.1|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||99.1|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|99.1|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|99.1|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|99.1|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|82.05|99.1|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|99.1|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|99.1|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||99.1|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||99.1|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|99.1|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|69.26|99.1|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||99.1|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|99.1|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|99.1|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||99.1|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||99.1|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||99.1|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|99.1|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|99.1|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|99.1|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|99.1|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|99.1|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||99.1|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|99.1|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|99.1|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|69.26|99.1|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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|106.56||||106.56|74.59|99.1|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|99.1|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|99.1|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||99.1|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||99.1|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||99.1|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|99.1|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|33.99|99.1|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|0|99.1|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|99.1|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||99.1|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]|UHC - BIND [206032]|106.56||||106.56|0|99.1|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||99.1|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|10.8|99.1|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||99.1|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|99.1|2.1
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AETNA [1015]|AETNA ACO WILCO [101532]|391.53||||391.53|0|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|391.53||||391.53|274.07|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|391.53||||391.53|195.77|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|391.53||||391.53|0|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|391.53||||391.53|0|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|391.53||||391.53|226.7|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|391.53||||391.53|158.57|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|391.53||||391.53|168.36|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|391.53||||391.53|192.63|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|391.53||||391.53|195.77|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|391.53||||391.53|254.49|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|391.53||||391.53|274.07|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|CORESOURCE [1315]|CORESOURCE [131500]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|391.53||||391.53|144.87|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|391.53||||391.53|332.8|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|GEHA [1415]|GEHA - ASA [141503]|391.53||||391.53|0|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|GROUP PENSION ADMIN [1450]|GPA [145000]|391.53||||391.53|274.07|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|HEALTHNET [1495]|HEALTHNET [149500]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|391.53||||391.53|168.36|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|391.53||||391.53|301.48|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|391.53||||391.53|364.12|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|391.53||||391.53|129.2|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|391.53||||391.53|254.49|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|391.53||||391.53|195.77|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|391.53||||391.53|0|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MULTIPLAN [1680]|HMA [168003]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MULTIPLAN [1680]|IHC HS [168011]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|391.53||||391.53|0|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|391.53||||391.53|254.49|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|391.53||||391.53|274.07|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|Self-pay|Self-pay|391.53||||391.53|117.46|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|391.53||||391.53|82.22|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|TRUSTMARK [2030]|STARMARK [203000]|391.53||||391.53|352.38|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|391.53||||391.53|124.9|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|UMR [2035]|UMR OPTIONS [203501]|391.53||||391.53|0|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|391.53||||391.53|0|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|391.53||||391.53|0|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|391.53||||391.53|144.87|364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|391.53||||391.53||364.12|82.22
100462|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC POLARUS 3 L20 IN TROCAR TIP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|391.53||||391.53|195.77|364.12|82.22
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|509.41||||509.41|0|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|509.41||||509.41|356.59|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|509.41||||509.41|254.71|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|509.41||||509.41|0|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|509.41||||509.41|0|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|509.41||||509.41|294.95|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|509.41||||509.41|206.31|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|509.41||||509.41|219.05|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|509.41||||509.41|250.63|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|509.41||||509.41|254.71|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|509.41||||509.41|331.12|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|509.41||||509.41|356.59|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|CORESOURCE [1315]|CORESOURCE [131500]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|509.41||||509.41|188.48|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|509.41||||509.41|433|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|GEHA [1415]|GEHA - ASA [141503]|509.41||||509.41|0|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|509.41||||509.41|356.59|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|HEALTHNET [1495]|HEALTHNET [149500]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|509.41||||509.41|219.05|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|509.41||||509.41|392.25|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|509.41||||509.41|473.75|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|509.41||||509.41|168.11|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|509.41||||509.41|331.12|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|509.41||||509.41|0|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|509.41||||509.41|0|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|MULTIPLAN [1680]|HMA [168003]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|MULTIPLAN [1680]|IHC HS [168011]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|509.41||||509.41|0|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|509.41||||509.41|331.12|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|509.41||||509.41|356.59|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|Self-pay|Self-pay|509.41||||509.41|152.82|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|509.41||||509.41|106.98|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|TRUSTMARK [2030]|STARMARK [203000]|509.41||||509.41|458.47|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|509.41||||509.41|162.5|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|UMR [2035]|UMR OPTIONS [203501]|509.41||||509.41|0|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|509.41||||509.41|0|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|509.41||||509.41|0|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|509.41||||509.41|188.48|473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|509.41||||509.41||473.75|106.98
100463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL 2.8MM POLARUS 3 SURGIBIT LONG STERILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|509.41||||509.41|254.71|473.75|106.98
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|AETNA ACO WILCO [101532]|218||||218|0|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|218||||218|152.6|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|218||||218|109|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|218||||218|0|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|218||||218|0|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|218||||218|126.22|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|218||||218|88.29|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|218||||218|93.74|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|218||||218|107.26|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|218||||218|109|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|218||||218|141.7|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|218||||218|152.6|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|CORESOURCE [1315]|CORESOURCE [131500]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|218||||218|80.66|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|218||||218|185.3|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|GEHA [1415]|GEHA - ASA [141503]|218||||218|0|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|GROUP PENSION ADMIN [1450]|GPA [145000]|218||||218|152.6|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HEALTHNET [1495]|HEALTHNET [149500]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|218||||218|93.74|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|218||||218|167.86|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|218||||218|202.74|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|218||||218|71.94|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|218||||218|141.7|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|218||||218|0|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|218||||218|0|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|MULTIPLAN [1680]|HMA [168003]|218||||218|76.3|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|MULTIPLAN [1680]|IHC HS [168011]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|218||||218|0|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|218||||218|141.7|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|218||||218|152.6|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|Self-pay|Self-pay|218||||218|65.4|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|218||||218|45.78|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|218||||218|3.64|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|TRUSTMARK [2030]|STARMARK [203000]|218||||218|196.2|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|218||||218|69.54|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|UMR [2035]|UMR OPTIONS [203501]|218||||218|0|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|218||||218|0|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|218||||218|0|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|218||||218|80.66|202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|218||||218||202.74|3.64
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|100 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|218||||218|109|202.74|3.64
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|9.3|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||9.3|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|9.3|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||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|AETNA [1015]|AMERICAN CONTINENTAL [101507]|10||||10|7|9.3|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|9.3|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|9.3|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|9.3|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|9.3|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|5|9.3|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|9.3|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|9.3|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||9.3|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|5.79|9.3|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|4.05|9.3|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|9.3|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|4.92|9.3|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|9.3|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|9.3|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|9.3|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||9.3|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||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|CIGNA [1260]|CIGNA - GREAT WEST [126009]|10||||10|7|9.3|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|9.3|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|9.3|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|9.3|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|9.3|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|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|FIRST HEALTH [1375]|BENVEO/UCS [137512]|10||||10|8.5|9.3|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|9.3|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|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|GEHA [1415]|GEHA - ASA [141503]|10||||10|0|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|GROUP PENSION ADMIN [1450]|GPA [145000]|10||||10|7|9.3|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||9.3|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|9.3|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|9.3|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|9.3|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|7.7|9.3|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|9.3|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|9.3|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||9.3|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||9.3|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|9.3|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|6.5|9.3|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||9.3|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|9.3|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|9.3|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||9.3|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||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|MULTIPLAN [1680]|HMA [168003]|10||||10||9.3|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|9.3|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|9.3|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|9.3|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|9.3|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|9.3|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||9.3|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|9.3|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|9.3|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|6.5|9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|10||||10|7|9.3|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|9.3|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|9.3|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||9.3|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||9.3|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||9.3|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|9.3|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|3.19|9.3|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|0|9.3|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|9.3|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||9.3|2.1
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1 tablet|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|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||9.3|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|9.3|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||9.3|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|9.3|2.1
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|638.57||||638.57|0|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|638.57||||638.57|447|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|638.57||||638.57|319.29|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|638.57||||638.57|0|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|638.57||||638.57|0|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|638.57||||638.57|369.73|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|638.57||||638.57|258.62|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|638.57||||638.57|274.59|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|638.57||||638.57|314.18|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|638.57||||638.57|319.29|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|638.57||||638.57|415.07|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|638.57||||638.57|447|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|CORESOURCE [1315]|CORESOURCE [131500]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|638.57||||638.57|10.8|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|638.57||||638.57|542.79|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|GEHA [1415]|GEHA - ASA [141503]|638.57||||638.57|0|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|638.57||||638.57|447|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|HEALTHNET [1495]|HEALTHNET [149500]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|638.57||||638.57|274.59|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|638.57||||638.57|491.7|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|638.57||||638.57|593.87|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|638.57||||638.57|210.73|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|638.57||||638.57|415.07|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|638.57||||638.57|319.29|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|638.57||||638.57|0|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|MULTIPLAN [1680]|HMA [168003]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|MULTIPLAN [1680]|IHC HS [168011]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|638.57||||638.57|0|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|638.57||||638.57|415.07|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|638.57||||638.57|447|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|Self-pay|Self-pay|638.57||||638.57|191.57|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|638.57||||638.57|134.1|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|TRUSTMARK [2030]|STARMARK [203000]|638.57||||638.57|574.72|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|638.57||||638.57|203.7|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|UMR [2035]|UMR OPTIONS [203501]|638.57||||638.57|0|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|638.57||||638.57|0|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|638.57||||638.57|0|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|638.57||||638.57|10.8|593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|638.57||||638.57||593.87|10.8
100557|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PIN FIXATION PERI-LOC VLP STAINLESS STEEL L25 MM OD2.7 MM TRIAL DISPOSABLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|638.57||||638.57|319.29|593.87|10.8
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|AETNA [1015]|AETNA ACO WILCO [101532]|3789||||3789|1326.15|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|3789||||3789|2652.3|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3789||||3789|1894.5|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3789||||3789|0|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3789||||3789|0|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3789||||3789|2193.83|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3789||||3789|1534.55|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3789||||3789|1629.27|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3789||||3789|1864.19|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3789||||3789|1894.5|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3789||||3789|2462.85|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|3789||||3789|2652.3|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|CORESOURCE [1315]|CORESOURCE [131500]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3789||||3789|974.41|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|3789||||3789|3220.65|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|GEHA [1415]|GEHA - ASA [141503]|3789||||3789|0|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|GROUP PENSION ADMIN [1450]|GPA [145000]|3789||||3789|2652.3|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3789||||3789|1326.15|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HEALTHNET [1495]|HEALTHNET [149500]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3789||||3789|1629.27|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3789||||3789|2917.53|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3789||||3789|3523.77|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3789||||3789|1250.37|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3789||||3789|2462.85|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3789||||3789|1894.5|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3789||||3789|0|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MULTIPLAN [1680]|HMA [168003]|3789||||3789|1326.15|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MULTIPLAN [1680]|IHC HS [168011]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3789||||3789|0|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3789||||3789|2462.85|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|3789||||3789|2652.3|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|Self-pay|Self-pay|3789||||3789|1136.7|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3789||||3789|795.69|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|TRUSTMARK [2030]|STARMARK [203000]|3789||||3789|3410.1|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3789||||3789|1208.69|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|UMR [2035]|UMR OPTIONS [203501]|3789||||3789|0|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3789||||3789|0|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3789||||3789|0|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3789||||3789|974.41|3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3789||||3789||3523.77|795.69
100558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BEARING 67MMX16MM VANGUARD E1 KNEE ANTERIOR STABILIZE TIBIAL|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3789||||3789|1894.5|3523.77|795.69
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]|AMERICAN CONTINENTAL [101507]|10||||10|7|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|5|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|5.79|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|4.05|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|4.92|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|CIGNA [1260]|CIGNA - GREAT WEST [126009]|10||||10|7|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|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]|BENVEO/UCS [137512]|10||||10|8.5|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 - ASA [141503]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|GROUP PENSION ADMIN [1450]|GPA [145000]|10||||10|7|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|7.7|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|6.5|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|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|PENDING SSI [1616]|PENDING SSI RCA [161601]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10||||10|6.5|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|10||||10|7|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|Self-pay|Self-pay|10||||10|3|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10||||10|2.1|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|TRIWEST [3750]|TRIWEST TWVACCN [375000]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|TRUSTMARK [2030]|STARMARK [203000]|10||||10|9|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10||||10|3.19|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|UMR [2035]|UMR OPTIONS [203501]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|10||||10|0|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|10||||10|3.7|9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|10||||10||9.3|2.1
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1 capsule|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|10||||10|5|9.3|2.1
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|AETNA [1015]|AETNA ACO WILCO [101532]|12945.75||||12945.75|4531.01|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|12945.75||||12945.75|9062.03|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12945.75||||12945.75|6472.88|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12945.75||||12945.75|0|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12945.75||||12945.75|0|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|12945.75||||12945.75|7495.59|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12945.75||||12945.75|5243.03|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12945.75||||12945.75|5566.67|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|12945.75||||12945.75|6369.31|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|12945.75||||12945.75|6472.88|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12945.75||||12945.75|8414.74|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|12945.75||||12945.75|9062.03|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|CORESOURCE [1315]|CORESOURCE [131500]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|12945.75||||12945.75|4911.05|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|12945.75||||12945.75|11003.89|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|GEHA [1415]|GEHA - ASA [141503]|12945.75||||12945.75|0|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|GROUP PENSION ADMIN [1450]|GPA [145000]|12945.75||||12945.75|9062.03|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|12945.75||||12945.75|4531.01|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|HEALTHNET [1495]|HEALTHNET [149500]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12945.75||||12945.75|5566.67|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12945.75||||12945.75|9968.23|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|HEALTHSMART [1505]|HEALTHSMART [150501]|12945.75||||12945.75|12039.55|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12945.75||||12945.75|4272.1|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12945.75||||12945.75|8414.74|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12945.75||||12945.75|6472.88|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12945.75||||12945.75|0|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|MULTIPLAN [1680]|HMA [168003]|12945.75||||12945.75|4531.01|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|MULTIPLAN [1680]|IHC HS [168011]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|12945.75||||12945.75|0|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12945.75||||12945.75|8414.74|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|12945.75||||12945.75|9062.03|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|Self-pay|Self-pay|12945.75||||12945.75|3883.72|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12945.75||||12945.75|2718.61|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|TRUSTMARK [2030]|STARMARK [203000]|12945.75||||12945.75|11651.18|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12945.75||||12945.75|4129.69|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|UMR [2035]|UMR OPTIONS [203501]|12945.75||||12945.75|0|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12945.75||||12945.75|0|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|12945.75||||12945.75|0|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|12945.75||||12945.75|4911.05|12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|12945.75||||12945.75||12039.55|2718.61
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|12945.75||||12945.75|6472.88|12039.55|2718.61
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|AETNA [1015]|AETNA ACO WILCO [101532]|30.66||||30.66|0|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|30.66||||30.66|21.46|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30.66||||30.66|15.33|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30.66||||30.66|0|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30.66||||30.66|0|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|30.66||||30.66|17.75|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30.66||||30.66|12.42|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30.66||||30.66|13.18|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|30.66||||30.66|15.08|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|30.66||||30.66|15.33|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30.66||||30.66|19.93|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|30.66||||30.66|21.46|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|CORESOURCE [1315]|CORESOURCE [131500]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|30.66||||30.66|11.34|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|30.66||||30.66|26.06|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|FIRST HEALTH [1375]|QUALCHOICE [137513]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|FMH BENEFIT SERVICES [1390]|FMH [139000]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|GEHA [1415]|GEHA - ASA [141503]|30.66||||30.66|0|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|GROUP PENSION ADMIN [1450]|GPA [145000]|30.66||||30.66|21.46|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|HEALTHNET [1495]|HEALTHNET [149500]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30.66||||30.66|13.18|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30.66||||30.66|23.61|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|HEALTHSMART [1505]|HEALTHSMART [150501]|30.66||||30.66|28.51|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|30.66||||30.66|10.12|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30.66||||30.66|19.93|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30.66||||30.66|0|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30.66||||30.66|0|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|MULTIPLAN [1680]|HMA [168003]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|MULTIPLAN [1680]|IHC HS [168011]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|PENDING SSI [1616]|PENDING SSI RCA [161601]|30.66||||30.66|0|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30.66||||30.66|19.93|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|30.66||||30.66|21.46|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|Self-pay|Self-pay|30.66||||30.66|9.2|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30.66||||30.66|6.44|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|TRIWEST [3750]|TRIWEST TWVACCN [375000]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|TRUSTMARK [2030]|STARMARK [203000]|30.66||||30.66|27.59|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30.66||||30.66|9.78|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|UMR [2035]|UMR OPTIONS [203501]|30.66||||30.66|0|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30.66||||30.66|0|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|30.66||||30.66|0|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|30.66||||30.66|11.34|28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|30.66||||30.66||28.51|6.44
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|0.25 mL|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|30.66||||30.66|15.33|28.51|6.44
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|AETNA [1015]|AETNA ACO WILCO [101532]|1399.83||||1399.83|0|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1399.83||||1399.83|979.88|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1399.83||||1399.83|699.91|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1399.83||||1399.83|0|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1399.83||||1399.83|0|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1399.83||||1399.83|810.5|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1399.83||||1399.83|566.93|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1399.83||||1399.83|601.92|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1399.83||||1399.83|688.71|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1399.83||||1399.83|699.91|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1399.83||||1399.83|909.89|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1399.83||||1399.83|979.88|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|CORESOURCE [1315]|CORESOURCE [131500]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1399.83||||1399.83|974.41|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1399.83||||1399.83|1189.85|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|GEHA [1415]|GEHA - ASA [141503]|1399.83||||1399.83|0|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|GROUP PENSION ADMIN [1450]|GPA [145000]|1399.83||||1399.83|979.88|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|HEALTHNET [1495]|HEALTHNET [149500]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1399.83||||1399.83|601.92|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1399.83||||1399.83|1077.87|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1399.83||||1399.83|1301.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1399.83||||1399.83|461.94|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1399.83||||1399.83|909.89|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1399.83||||1399.83|699.91|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1399.83||||1399.83|0|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|MULTIPLAN [1680]|HMA [168003]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|MULTIPLAN [1680]|IHC HS [168011]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1399.83||||1399.83|0|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1399.83||||1399.83|909.89|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1399.83||||1399.83|979.88|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|Self-pay|Self-pay|1399.83||||1399.83|419.95|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1399.83||||1399.83|293.96|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|TRUSTMARK [2030]|STARMARK [203000]|1399.83||||1399.83|1259.84|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1399.83||||1399.83|446.54|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|UMR [2035]|UMR OPTIONS [203501]|1399.83||||1399.83|0|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1399.83||||1399.83|0|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1399.83||||1399.83|0|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1399.83||||1399.83|974.41|1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1399.83||||1399.83||1301.84|293.96
100848|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR 0 MM OD26 MM HIP|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1399.83||||1399.83|699.91|1301.84|293.96
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|1.64||||1.64|0|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.64||||1.64|1.15|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.64||||1.64|0.82|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1.64||||1.64|0|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1.64||||1.64|0|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|1.64||||1.64|0.95|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1.64||||1.64|0.66|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1.64||||1.64|0.71|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|1.64||||1.64|0.81|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|1.64||||1.64|0.82|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.64||||1.64|1.07|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1.64||||1.64|1.15|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|1.64||||1.64|0.61|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1.64||||1.64|1.4|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|GEHA [1415]|GEHA - ASA [141503]|1.64||||1.64|0|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|1.64||||1.64|1.15|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.64||||1.64|0.71|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1.64||||1.64|1.26|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|1.64||||1.64|1.53|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.64||||1.64|0.54|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1.64||||1.64|1.07|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1.64||||1.64|0|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1.64||||1.64|0|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|MULTIPLAN [1680]|HMA [168003]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|MULTIPLAN [1680]|IHC HS [168011]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|1.64||||1.64|0|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1.64||||1.64|1.07|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1.64||||1.64|1.15|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|Self-pay|Self-pay|1.64||||1.64|0.49|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1.64||||1.64|0.34|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|TRUSTMARK [2030]|STARMARK [203000]|1.64||||1.64|1.48|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.64||||1.64|0.52|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|UMR [2035]|UMR OPTIONS [203501]|1.64||||1.64|0|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1.64||||1.64|0|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|1.64||||1.64|0|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|1.64||||1.64|0.61|1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|1.64||||1.64||1.53|0.34
100914|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|POUCH OSTOMY SUR-FIT NATURA NATURA + INVISICLOSE LOCK-IT POCKET L12 IN OD2 1/4 IN 1 SIDE COMFORT PANEL TAIL CLOSURE FLANGE TRANSPARENT LATEX FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|1.64||||1.64|0.82|1.53|0.34
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|3746.9||||3746.9|1311.42|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|3746.9||||3746.9|2622.83|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3746.9||||3746.9|1873.45|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3746.9||||3746.9|0|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3746.9||||3746.9|0|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3746.9||||3746.9|2169.46|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3746.9||||3746.9|1517.49|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3746.9||||3746.9|1611.17|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3746.9||||3746.9|1843.47|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3746.9||||3746.9|1873.45|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3746.9||||3746.9|2435.49|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|3746.9||||3746.9|2622.83|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3746.9||||3746.9|974.41|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|3746.9||||3746.9|3184.87|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|GEHA [1415]|GEHA - ASA [141503]|3746.9||||3746.9|0|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|3746.9||||3746.9|2622.83|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3746.9||||3746.9|1311.42|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3746.9||||3746.9|1611.17|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3746.9||||3746.9|2885.11|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3746.9||||3746.9|3484.62|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3746.9||||3746.9|1236.48|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3746.9||||3746.9|2435.49|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3746.9||||3746.9|1873.45|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3746.9||||3746.9|0|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MULTIPLAN [1680]|HMA [168003]|3746.9||||3746.9|1311.42|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MULTIPLAN [1680]|IHC HS [168011]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3746.9||||3746.9|0|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3746.9||||3746.9|2435.49|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|3746.9||||3746.9|2622.83|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|Self-pay|Self-pay|3746.9||||3746.9|1124.07|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3746.9||||3746.9|786.85|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|TRUSTMARK [2030]|STARMARK [203000]|3746.9||||3746.9|3372.21|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3746.9||||3746.9|1195.26|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UMR [2035]|UMR OPTIONS [203501]|3746.9||||3746.9|0|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3746.9||||3746.9|0|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3746.9||||3746.9|0|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3746.9||||3746.9|974.41|3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3746.9||||3746.9||3484.62|786.85
101000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 3 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3746.9||||3746.9|1873.45|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|3746.9||||3746.9|1311.42|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|3746.9||||3746.9|2622.83|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3746.9||||3746.9|1873.45|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3746.9||||3746.9|0|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3746.9||||3746.9|0|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3746.9||||3746.9|2169.46|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3746.9||||3746.9|1517.49|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3746.9||||3746.9|1611.17|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3746.9||||3746.9|1843.47|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3746.9||||3746.9|1873.45|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3746.9||||3746.9|2435.49|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|3746.9||||3746.9|2622.83|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3746.9||||3746.9|974.41|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|3746.9||||3746.9|3184.87|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|GEHA [1415]|GEHA - ASA [141503]|3746.9||||3746.9|0|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|3746.9||||3746.9|2622.83|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3746.9||||3746.9|1311.42|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3746.9||||3746.9|1611.17|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3746.9||||3746.9|2885.11|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3746.9||||3746.9|3484.62|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3746.9||||3746.9|1236.48|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3746.9||||3746.9|2435.49|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3746.9||||3746.9|1873.45|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3746.9||||3746.9|0|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MULTIPLAN [1680]|HMA [168003]|3746.9||||3746.9|1311.42|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MULTIPLAN [1680]|IHC HS [168011]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3746.9||||3746.9|0|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3746.9||||3746.9|2435.49|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|3746.9||||3746.9|2622.83|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|Self-pay|Self-pay|3746.9||||3746.9|1124.07|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3746.9||||3746.9|786.85|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|TRUSTMARK [2030]|STARMARK [203000]|3746.9||||3746.9|3372.21|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3746.9||||3746.9|1195.26|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UMR [2035]|UMR OPTIONS [203501]|3746.9||||3746.9|0|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3746.9||||3746.9|0|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3746.9||||3746.9|0|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3746.9||||3746.9|974.41|3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3746.9||||3746.9||3484.62|786.85
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3746.9||||3746.9|1873.45|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA [1015]|AETNA ACO WILCO [101532]|3746.9||||3746.9|1311.42|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|3746.9||||3746.9|2622.83|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3746.9||||3746.9|1873.45|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3746.9||||3746.9|0|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3746.9||||3746.9|0|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3746.9||||3746.9|2169.46|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3746.9||||3746.9|1517.49|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3746.9||||3746.9|1611.17|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3746.9||||3746.9|1843.47|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3746.9||||3746.9|1873.45|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3746.9||||3746.9|2435.49|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|3746.9||||3746.9|2622.83|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|CORESOURCE [1315]|CORESOURCE [131500]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3746.9||||3746.9|974.41|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|3746.9||||3746.9|3184.87|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|GEHA [1415]|GEHA - ASA [141503]|3746.9||||3746.9|0|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|3746.9||||3746.9|2622.83|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3746.9||||3746.9|1311.42|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHNET [1495]|HEALTHNET [149500]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3746.9||||3746.9|1611.17|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3746.9||||3746.9|2885.11|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3746.9||||3746.9|3484.62|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3746.9||||3746.9|1236.48|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3746.9||||3746.9|2435.49|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3746.9||||3746.9|1873.45|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3746.9||||3746.9|0|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MULTIPLAN [1680]|HMA [168003]|3746.9||||3746.9|1311.42|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MULTIPLAN [1680]|IHC HS [168011]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3746.9||||3746.9|0|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3746.9||||3746.9|2435.49|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|3746.9||||3746.9|2622.83|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|Self-pay|Self-pay|3746.9||||3746.9|1124.07|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3746.9||||3746.9|786.85|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|TRUSTMARK [2030]|STARMARK [203000]|3746.9||||3746.9|3372.21|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3746.9||||3746.9|1195.26|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UMR [2035]|UMR OPTIONS [203501]|3746.9||||3746.9|0|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3746.9||||3746.9|0|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3746.9||||3746.9|0|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3746.9||||3746.9|974.41|3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3746.9||||3746.9||3484.62|786.85
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE CEMENT TOTAL STABILIZE STERILE LATEX FREE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3746.9||||3746.9|1873.45|3484.62|786.85
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|298.91||||298.91|0|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|298.91||||298.91|209.24|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|298.91||||298.91|149.46|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|298.91||||298.91|0|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|298.91||||298.91|0|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|298.91||||298.91|173.07|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|298.91||||298.91|121.06|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|298.91||||298.91|128.53|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|298.91||||298.91|147.06|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|298.91||||298.91|149.46|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|298.91||||298.91|194.29|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|298.91||||298.91|209.24|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|CORESOURCE [1315]|CORESOURCE [131500]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|298.91||||298.91|10.8|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|298.91||||298.91|254.07|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|GEHA [1415]|GEHA - ASA [141503]|298.91||||298.91|0|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|298.91||||298.91|209.24|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|HEALTHNET [1495]|HEALTHNET [149500]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|298.91||||298.91|128.53|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|298.91||||298.91|230.16|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|298.91||||298.91|277.99|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|298.91||||298.91|98.64|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|298.91||||298.91|194.29|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|298.91||||298.91|149.46|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|298.91||||298.91|0|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|MULTIPLAN [1680]|HMA [168003]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|MULTIPLAN [1680]|IHC HS [168011]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|298.91||||298.91|0|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|298.91||||298.91|194.29|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|298.91||||298.91|209.24|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|Self-pay|Self-pay|298.91||||298.91|89.67|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|298.91||||298.91|62.77|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|TRUSTMARK [2030]|STARMARK [203000]|298.91||||298.91|269.02|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|298.91||||298.91|95.35|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|UMR [2035]|UMR OPTIONS [203501]|298.91||||298.91|0|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|298.91||||298.91|0|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|298.91||||298.91|0|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|298.91||||298.91|10.8|277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|298.91||||298.91||277.99|10.8
101082|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 HEXALOBE L18 MM OD3.5 MM HUMERUS NONLOCK LOW PROFILE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|298.91||||298.91|149.46|277.99|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|AETNA [1015]|AETNA ACO WILCO [101532]|3384.84||||3384.84|1184.69|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|3384.84||||3384.84|2369.39|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3384.84||||3384.84|1692.42|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3384.84||||3384.84|0|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3384.84||||3384.84|0|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|3384.84||||3384.84|1959.82|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3384.84||||3384.84|1370.86|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3384.84||||3384.84|1455.48|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|3384.84||||3384.84|1665.34|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|3384.84||||3384.84|1692.42|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3384.84||||3384.84|2200.15|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|3384.84||||3384.84|2369.39|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|CORESOURCE [1315]|CORESOURCE [131500]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|3384.84||||3384.84|10.8|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|3384.84||||3384.84|2877.11|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|GEHA [1415]|GEHA - ASA [141503]|3384.84||||3384.84|0|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|GROUP PENSION ADMIN [1450]|GPA [145000]|3384.84||||3384.84|2369.39|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|3384.84||||3384.84|1184.69|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|HEALTHNET [1495]|HEALTHNET [149500]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3384.84||||3384.84|1455.48|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3384.84||||3384.84|2606.33|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|HEALTHSMART [1505]|HEALTHSMART [150501]|3384.84||||3384.84|3147.9|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3384.84||||3384.84|1117|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3384.84||||3384.84|2200.15|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3384.84||||3384.84|1692.42|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3384.84||||3384.84|0|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|MULTIPLAN [1680]|HMA [168003]|3384.84||||3384.84|1184.69|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|MULTIPLAN [1680]|IHC HS [168011]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|3384.84||||3384.84|0|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3384.84||||3384.84|2200.15|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|3384.84||||3384.84|2369.39|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|Self-pay|Self-pay|3384.84||||3384.84|1015.45|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3384.84||||3384.84|710.82|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|TRUSTMARK [2030]|STARMARK [203000]|3384.84||||3384.84|3046.36|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3384.84||||3384.84|1079.76|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|UMR [2035]|UMR OPTIONS [203501]|3384.84||||3384.84|0|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3384.84||||3384.84|0|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|3384.84||||3384.84|0|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|3384.84||||3384.84|10.8|3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|3384.84||||3384.84||3147.9|10.8
101083|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE ACU-LOC 2 WIDE L59 MM X W29 MM RADIAL RIGHT DISTAL VOLAR VARIABLE ANGLE NONSTERILE 2.3 MM SCREW|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|3384.84||||3384.84|1692.42|3147.9|10.8
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|AETNA ACO WILCO [101532]|926.2||||926.2|0|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|926.2||||926.2|648.34|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|926.2||||926.2|463.1|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|926.2||||926.2|0|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|926.2||||926.2|0|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BCBS TRAD/HMO/PPO/POS NM [115513]|926.2||||926.2|536.27|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|926.2||||926.2|375.11|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|926.2||||926.2|398.27|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|BCBS [1155]|BLUE CROSS NLP NEW MEXICO [115529]|926.2||||926.2|455.69|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|BENEFIT MANAGEMENT [1175]|NEW MEXICO INSURANCE POOL [117501]|926.2||||926.2|463.1|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|926.2||||926.2|602.03|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|CIGNA [1260]|CIGNA - GREAT WEST [126009]|926.2||||926.2|648.34|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|CORESOURCE [1315]|CORESOURCE [131500]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|ENABLECOMP [1350]|W/C WORK COMP ENABLECOMP [135000]|926.2||||926.2|342.69|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|FIRST HEALTH [1375]|BENVEO/UCS [137512]|926.2||||926.2|787.27|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|FIRST HEALTH [1375]|QUALCHOICE [137513]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|FMH BENEFIT SERVICES [1390]|FMH [139000]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|GEHA [1415]|GEHA - ASA [141503]|926.2||||926.2|0|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA [145000]|926.2||||926.2|648.34|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|GROUP PENSION ADMIN [1450]|GPA-TLC [145007]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|HEALTHNET [1495]|HEALTHNET [149500]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|926.2||||926.2|398.27|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|926.2||||926.2|713.17|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|HEALTHSMART [1505]|HEALTHSMART [150501]|926.2||||926.2|861.37|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|926.2||||926.2|305.65|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|INDIAN HEALTH SERVICES [1535]|WITHDRAWAL STABILIZATION-CHICKASAW [153543]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|926.2||||926.2|602.03|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|926.2||||926.2|0|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|926.2||||926.2|0|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|MULTIPLAN [1680]|HMA [168003]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|MULTIPLAN [1680]|IHC HS [168011]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|PENDING COUNTY RCA [3910]|PENDING COUNTY RCA [391000]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|PENDING SSI [1616]|PENDING SSI RCA [161601]|926.2||||926.2|0|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|926.2||||926.2|602.03|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|926.2||||926.2|648.34|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|Self-pay|Self-pay|926.2||||926.2|277.86|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|926.2||||926.2|194.5|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|TRIWEST [3750]|TRIWEST TWVACCN [375000]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|TRUSTMARK [2030]|STARMARK [203000]|926.2||||926.2|833.58|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|926.2||||926.2|295.46|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|UMR [2035]|UMR OPTIONS [203501]|926.2||||926.2|0|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|926.2||||926.2|0|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|UNITED HEALTHCARE [2060]|UHC - BIND [206032]|926.2||||926.2|0|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|WORKER'S COMP [2125]|CNA INSURANCE WC [2125100]|926.2||||926.2|342.69|861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|WORKER'S COMP [2125]|DEPARTMENT OF LABOR (WC) [212507]|926.2||||926.2||861.37|194.5
101094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM NEGATIVE PRESSURE PICO 7 L30 CM X W10 CM STERILE LATEX FREE DISPOSABLE|1|ZELIS [2385]|NEW MEXICO MEDICAL INSURANCE POOL [238502]|926.2||||926.2|463.1|861.37|194.5
101095|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL PERSONA COCR POROUS 7 STANDARD KNEE LEFT CRUCIATE RETAIN STERILE|1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8630.5||||8630.5|7767.45|8026.37|974.41
101095|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL PERSONA COCR POROUS 7 STANDARD KNEE LEFT CRUCIATE RETAIN STERILE|1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8630.5||||8630.5||8026.37|974.41
101095|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL PERSONA COCR POROUS 7 STANDARD KNEE LEFT CRUCIATE RETAIN STERILE|1|AETNA [1015]|AETNA ACO WILCO [101532]|8630.5||||8630.5|3020.68|8026.37|974.41
101095|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL PERSONA COCR POROUS 7 STANDARD KNEE LEFT CRUCIATE RETAIN STERILE|1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8630.5||||8630.5||8026.37|974.41
101095|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL PERSONA COCR POROUS 7 STANDARD KNEE LEFT CRUCIATE RETAIN STERILE|1|AETNA [1015]|AMERICAN CONTINENTAL [101507]|8630.5||||8630.5|6041.35|8026.37|974.41
101095|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL PERSONA COCR POROUS 7 STANDARD KNEE LEFT CRUCIATE RETAIN STERILE|1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8630.5||||8630.5|7767.45|8026.37|974.41
101095|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL PERSONA COCR PORO